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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin 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 No Example: cash assistance, SNAP, Medicaid, etc. Have you been quarantined by the Health Department? Yes No Has your child/ren been quarantined by the Health Department?* Yes No If '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 files Max. file size: 128 MB. Please upload notification letter from the school district and/or the Health Department that you received. COVID-19 QUICKLINKSHelp with BillsQuarantined Student HelpVolunteer Now211 NE MichiganReopen Bay CountyBay County Health Dept.
