(201) 996-9100 Bergen / (201) 533-4407 Hudson

COVID-19 Community Response Program

Funding Application

 

Dear Applicant:

Welcome to the COVID-19 Community Response Program, administered by Heightened Independence and Progress (hip) in Bergen and Hudson Counties. The program will address food insecurities, personal protective equipment, assistive devices (medical and non-medical), transportation, in home support services, emergency rental and utility assistance, because of COVID-19. For us to be more efficient in evaluating your request for funding, we will need your cooperation and diligence. Our program coordinators are available to assist you.

The following items must be enclosed:

  • APPLICATION: Fully complete the 3-part application, all information is required.
  • MEDICAL PRESCRIPTION: It should state your disability (COPD, end stage renal failure, lung cancer, diabetes, heart disease, developmental delay, etc.) and the reason you need the item you are requesting. The doctor, or other health care provider, may fax it directly to us.
  • ONE-TIME EMERGENCY RENTAL OR UTILITY ASSISTANCE: Please include a copy of the lease, utility bill and documentation of past due amount.
  • PROOF OF INCOME is required. Submit most recent income verification (Social Security, pension, wages, etc.). We will require information about income changes due to COVID-19 circumstances.
  • If you are applying for an air conditioner or home modification, a letter from landlord, granting you permission to obtain/install item, must be included. The program does not provide installation, installing air conditioners is the consumers responsibility. You may call the ASK Umbrella Program at 1-973-200-4499 for air conditioner installation assistance.
  • The COVID-19 Community Response Program can also provide a one-time $250 funding towards the purchase of incontinent or wound care supplies, for individuals in need.

INDEPENDENT LIVING PLAN is a tool used to assist consumers to meet their goals. Please complete the section that is moat appropriate.

Due to the high volume of applications we receive, it is very important that you complete and email this application promptly. Please note that hip cannot reimburse you for any paid bill(s). hip makes payments directly to the vendor. We will not be able to process your request, until all documents are received.

Each application will be reviewed, and funding will be determined based on needs.

hip has two locations to serve the community If you have any questions or need assistance completing the application, please contact us at the office in your county.

  • hip Bergen County (201) 996-9100 ext. 18 or email at mvalentin@hipcil.org
  • hip Hudson County (201) 533-4407 or email mgonzalez@hipcil.org

Mail application to: Heightened Independence and Progress (hip)

Attn: COVID-19 Community Response Program

  • 131 Main Street, Suite 120 Hackensack, NJ 07601 for Bergen County residents
  • 35 Journal Square Suite 703, Jersey City, NJ 07306 for Hudson County residents

 

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