United for ALICEAssistance is available to those experiencing a loss of income due to COVID-19 Quarantines 1Income Validation2Program Application During the COVID-19 pandemic, ALICE (asset limited, income constrained, employed) families are being uniquely impacted. People who are working and typically able to survive on their budgets are experiencing a lapse in income during quarantines, either the employee themselves or their children. This program is designed to help bridge that gap and prevent families from getting behind on bills, which can cause a ripple effect. You may qualify if you have missed work due to a COVID-19 quarantine and fall within the ALICE income guidelines. See below:Using the chart above identify the background color of the cell that represents your household.*SelectWhiteBlueGreyWe are sorry, your household does not qualify for this program at this time.There are programs that can help. Start by visiting 211nemichigan.org or by dialing 2-1-1 anytime 24/7.We are sorry, your household does not qualify for this program at this time.Some programs may be available to help, start by visiting 211nemichigan.org or by dialing 2-1-1 anytime 24/7 Date MM slash DD slash YYYY Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Employer*Documentation from this employer will be required to verify a loss or reduction of income.Annual Household Income*Household Size123456789101112Do you receive state or federal assistance?* Yes NoExample: cash assistance, SNAP, Medicaid, etc.Have you been quarantined by the Health Department? Yes NoHas your child/ren been quarantined by the Health Department?* Yes NoIf 'YES', what school do they attend?**MUST be located in BAY COUNTYIf 'YES', what grade are they in?*Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeDate of Quarantine* MM slash DD slash YYYY Length of Quarantine*Please enter a number from 1 to 14.File Drop files here or Select filesMax. file size: 128 MB.Please upload notification letter from the school district and/or the Health Department that you received. COVID-19 QUICKLINKS Help with Bills Quarantined Student Help Volunteer Now 211 NE Michigan Reopen Bay County Bay County Health Dept.