Support Services Intake 


With a vision of 'Equity for All', the Urban League of Metropolitan Seattle (ULMS) empowers those we serve by providing programming and services designed to support and encourage self-sufficiency in all aspects of life. Our six areas of focus include:

  • Advocacy & Civic Engagement
  • Education
  • Housing
  • Public Health
  • Workforce Development
  • Entrepreneurship

If you are in need of assistance, we'd love to help! The first step in accessing our ULMS programs and services is to complete the following Support Services Intake. This application will help us learn more about your current economic circumstances and help us to assess which programs or services will best align with your needs! 



Personal Information 








Contact Information



Mailing Address




Demographics

Diversity & Inclusion Statement: Urban League of Metropolitan Seattle (ULMS) prides itself on practicing diversity and inclusion in everything we do. We prohibit discrimination based on age, race, disability, ethnicity, marital or family status, national origin, religion, gender, sexual orientation, veteran status, genetic information, gender identity, medical condition or any other characteristic protected by law. Our programs specialize in serving clients of diverse ethnicities, genders and include those who are homeless and/or post incarcerated. All are treated with the utmost dignity, respect, and courtesy. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.



















Household Information





Use semicolon to seperate (;) eg 2;6;10




If you are fleeing, you may find additional assistance from the Washington Coalition Against Domestic Violence Hotline at 877-737-0242 or 206-737-0242. 

Head of Household: Must be legally single, pay more than half of household expenses and have either a qualified dependent living with you for at least half the year or a parent for whom you pay more than half their living arrangements.


Living Situation










Systemic Barriers













Education



Health Information











Benefits and Insurance
Non-cash Benefits


Health Insurance


Cash Benefits

Do you or your family have any of the cash benefits below? Please include the amount for each benefit. If you don't have a certain benefit please type "0".


If none, please type "0".

If none, please type "0".

If none, please type "0".

If none, please type "0".

If none, please type "0".

If none, please type "0".

If none, please type "0".

If none, please type "0".

If none, please add "0".

If none, please add "0".

If none, please add "0".

If none, please add "0".

If none, please add "0".

If none, please add "0".

If none, please add "0".

Financial Information
Fiscal Year 2023 HUD Income Limits Summary 


Employment Information







If you have not worked in the past year (12 months) please enter 0
Employment History

Fill out the information below using your current job OR most recent job if currently unemployed.








Veteran Status
The King County Veterans' Program (KCVP) definition & its eligibility requirements differs from the U.S. Veterans Administration's eligibility in one aspect, regardless of discharge status (including dishonorable discharge): only one day of military service is required to qualify.









Program Awareness

Emergency Contact





Application Signature