MAC 2022    Need Help Request - Non-Financial

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PLEASE NOTE:  THIS FORM IS NOT FOR FINANCIAL ASSISTANCE. ANY REQUEST FOR RENT OR UTILITIES WILL BE DENIED. We take those rent/utility requests from the ARCHI application - https://archicollaborative.org/research-resources/help/


Filling out this form does not guarantee services. If we are unable to assist you we will do our best to give you information on other assistance resources. MAC currently serves 10 zip codes in Atlanta for food and MARTA – 30303, 30308, 30309, 30310, 30312, 30313, 30314, 30315, 30318, and 30363.  

For information on MAC’s guidelines for assistance please Click Here


THE FORMATS OF FIELDS FOR YOUR ANSWERS MUST BE CORRECT (DASHES, SLASHES, ETC.) THE DATABASE WILL NOT ACCEPT ANSWERS OUT OF FORMAT OR OUT OF DATE.

Fields with a red asterisk * are required.

MAC Assistance Requests

PLEASE NOTE: Appointments are required for assistance. MAC Has moved into our new space located at 613 Spring Street NW, Atlanta GA 30308, right across from The Varsity, in what used to be Goodfellas Pizza. It is one block from North Avenue MARTA station. For Directions click here - https://midtownassistancecenter.org/contact-us/.


Personal Information











Address












Landlord and Rental information



TOTAL HOUSEHOLD INCOME PER MONTH                                                                                                                                            What was/is your total household income after taxes ?                                                                                                                     ROUND TO THE NEAREST DOLLAR - ENTER NUMBERS ONLY - NO DECIMALS  - if none enter 0

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per month

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per month

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Your Personal Story

Consent to Release of Information and Liability Release


AFTER YOU SUBMIT BELOW YOU MUST SIGN ON THE NEXT PAGE. Scroll all the way down to the bottom of the page. You will be asked for your E-Signature. You will have to sign and enter your name and email again. It will send 2 emails - a notification and a confirmation email to the email address you provide. You must verify (click) the link in your confirmation email with subject "Verify Signed Response" from no-reply@formassembly.com to complete the application for assistance. Please check to make sure your email address is correct. Sometimes these emails are going to Junk/Spam folders, so please look there as well.