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Brockton Together Fund

If you are a Brockton resident in need of financial help due to Covid-19, please complete this form. We will respond within 7 business days of submission. Filling out this form does not guarantee that you will receive funds. 
1. Contact Information
This question requires a valid email address.
2. Preferred language should we need to contact you:  *This question is required.
3. Are you currently employed? *This question is required.
4. Full time or Part Time?
4. Have you applied for unemployment? *This question is required.
5. How many people are in your Household (including yourself)?
  *This question is required.
6. Please indicate the area in which you MOST need assistance: *This question is required.
7. Please provide information regarding your landlord
7. Please provide information regarding your mortgage
7. Please upload proof of residency.

Examples of Proof of Residency:
  • Vehicle registration card or title
  • Voter registration card
  • Utility or telephone bill
  • Checking or savings account statement
  • Property tax bill or receipt
  • Mortgage account or proof of home ownership
  • Residential rental contract (apartment lease or other rental of real property)
If using a smart phone, you are able to take a photo of your documentation. 

Please note- if your proof of residency and your proof of owed rent/mortgage are on the same document, please upload the same document to both locations.  *This question is required.
7. Please upload proof of owed rent or mortgage.

Examples:
  • Letter from your landlord
  • Mortgage bill
  • Rent invoice
If using a smart phone, you are able to take a photo of your documentation. 

Please note- if your proof of residency and your proof of owed rent/mortgage are on the same document, please upload the same document to both locations. 
  *This question is required.
7. Please provide information regarding your utilities
7. I attest that the above information is true, to the best of my knowledge. You may be asked to provide documentation as proof of your current financial status. *This question is required.