Client Application

This application is for Rent, Utilities or Car Repair requests only.

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Client Intake
(Select to view all options)

Por favor, haga clic en el botón rojo "Español" si lo prefiere.

This information is needed for funding and grants so that we may provide this service.
Homeless

Employer Information

We require permission to contact your employer *

Employer Information

We require permission to contact your employer *
Limit 300 characters
Are there other adults in your household? *

Other Adults in Your Household

Are there children in your household? *

Children in Your Household

What financial assistance is needed? (Check all that apply) *
¿Qué asistencia financiera se necesita? (Marque todo lo que corresponda) *

Rent Assistance

How much rent is owed?

We require permission to contact your landlord *

Rent Assistance

How much rent is owed?

We require permission to contact your landlord *

Utility Assistance

How much is the bill?

This is required for the case manager.
We require permission to contact your utility company *

From October 1st – May 15th, you must call WestCap at 715-265-4271 to apply for utility assistance before our Case Manager calls you.

Utility Assistance

How much is the bill?

This is required for the case manager.
We require permission to contact your utility company *

From October 1st – May 15th, you must call WestCap at 715-265-4271 to apply for utility assistance before our Case Manager calls you.

Car Repair Assistance

Do you have an car repair estimate? *
An estimate is required when the case manager calls you. If "No" is selected a list of approved shops will be displayed.

An estimate is required for assistance. Please contact an approved car repair shop.

Car Repair Assistance

Do you have an car repair estimate? *
An estimate is required when the case manager calls you. If "No" is selected a list of approved shops will be displayed.