United Way of South HR

Please select one of the following to describe yourself:*
- Small Business
- Individual or Household

Please enter your ZIP code:*
Which of the following circumstances related to COVID-19 apply to you or your household?*
- Loss of employment or decreased hours
- Decrease in wages or earnings
- Unexpected expenses
- No childcare
- Contracted virus
- High risk of infection
- Lost child/spousal support
- Inability to find work
- None of the above

Before identifying your needs, please provide some general information. You will select types of services and assistance in the next section. Your contact information will be shared with relevant partners to connect you to resources.
Name*
First Name Last Name
Email*
Phone*
Are you currently employed?*
- Yes, Part-Time
- Yes, Full-Time
- No
Birthdate
Date Format: MM slash DD slash YYYY
I am interested in receiving a phone call from a trained care coordinator to discuss available resources.
I am a veteran or military-connected family member.

Please check next to the boxes below that describe your needs and complete the questions associated with each need. The additional information requested helps us connect you to the right programs and resources or work directly with your service provider to pay outstanding balances on your behalf. Helping you navigate the challenges presented by COVID-19 is our top priority!
Food
Food
Within the past 12 months, were you worried about whether your food would run out before you got money to buy more?
- Yes
- No
Within the past 12 months, did the food you bought just not last and you didn’t have money to get more?
- Yes
- No
Are you eligible for any federal nutrition programs? Check all that apply.
- Supplemental Nutrition Assistance Program (SNAP)
- Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
- Child and Adult Care Food Program (CACFP)
- Summer Food Service Program
- National School Lunch Program, School Breakfast Program or Special Milk Program
Are you currently participating in any federal nutrition programs? Check all that apply.
- Supplemental Nutrition Assistance Program (SNAP)
- Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
- Child and Adult Care Food Program (CACFP)
- Summer Food Service Program
- National School Lunch Program, School Breakfast Program or Special Milk Program
Employment
Employment
Are you interested in receiving education and/or training?
- Yes
- No
In what?
Do you have reliable transportation?
- Yes
- No
Rental Assistance
Rental Assistance
Property manager or management company
Your Home Address
Street 1 Street 2 City State Zip
Account number
Balance due
If you are seeking financial assistance for rent or utilities bills, the address you enter here must match the address on file with your service provider.
§ If we do not already have a partnership or agreement on file with your property management or landlord company, it may take us a few days to connect and process your assistance. If you are experiencing a housing crisis and need immediate help, please call the Housing Crisis Hotline at 757-587-4202.
Utilities
Utilities
Utility provider
Account number
Another Utility need
Utility provider*
Account number*
Estimated amount owed
Balance due
Enter another utility need
Childcare
Childcare
Which of the following applies to you?
- I need help finding childcare
- I already have childcare but need help paying for it
Need help finding childcare? Visit Childcare Aware of Virginia to search for childcare or connect with assistance.
Number of children
Provider
Health
Health
Which of the following applies to you?
- I need help paying my medical bills
- I need help accessing medical care
- I need help accessing mental health services
Company
Balance due
By signing the box below, you confirm that the information you have entered above is accurate and you are eligible to receive assistance—you are 18 years or older of age, you are a resident of Virginia Beach, and you have experienced a COVID-related impact.
Your signature additionally confirms your consent to allowing the Virginia Beach Pandemic Relief Partnership to share the information you have provided with relevant service providers and organizations for the purposes of distributing financial assistance and connecting you to the resources you have requested.
Signature*

Get Started

Step 1 of 4

VBrelief.org is a partnership of:

CONTACT

If you have questions or need assistance with completing the form,
please call 757-774-6264

Get Started

Step 1 of 4

VBrelief.org is a partnership of:

CONTACT

If you have questions or need assistance with completing the form, please call 757-774-6264

If you have questions or need assistance with completing the form,
please call 757-774-6264