Financial Services Offered by North Gwinnett Co-Op

Please Note: A person’s legal status does not determine service eligibility.

Applications for financial assistance are closed for the remainder of the calendar year and will resume in January, 2025.

Prescription assistance available clients with membership cards only.
To receive a membership card, you must be an active client and submit the following documents: Two months of all banking/financials for all adults in the home, IDs for all adults in the home, birth certificates for all children in the home, the utility bill you are seeking assistance with, and lease/mortgage statement. BILL and/or LEASE must be in applicants name.
Other documents may be required.
Please complete the financial assistance request form.
DO NOT FILL OUT MULTIPLE REQUESTS.
Maximum $150.00 per month allowed.
We will call you when your check is ready.

Complete the financial assistance request form.
DO NOT FILL OUT MULTIPLE REQUESTS.
A staff member will contact you to go over your request. Please be sure to list your correct phone number and email. We will attempt to reach you by phone first. If we can not reach you by phone, we will email you.
Due to the high volume of request, please allow 3 business days for a response. Please be sure to check your voicemail and/or email on a regular basis.

First Name*
Last Name*
Street Address*
City*
ZIP/Postal Code*
Phone Number*
Email*
Number of Persons 18 and older living in the home*
Number of Persons 17 and under living in the home*
Translator Required?*
- No
- Yes
If yes, what language?
Type of assistance seeking:*
- Medication
- Utility Assistance
Brief description of reason for your request for assistance:*
Acknowledgement*
I acknowledge that the North Gwinnett Co-Op does not cover housing (rent or mortgage payments), hotel expenses, re-connect fees or prepaid accounts for utilities. Additionally, the North Gwinnett Co-Op does not pay for Connection or Re-Connection Fees.
Consent*
Acknowledgement: By submitting this form, you understand that you are requesting financial assistance. One of our staff members will email you a list of required documents in order for your request to be processed.
Once documents are received, they will be reviewed and determined if the Co-Op will be able to assist your need. (Submission of documents does not guarantee assistance.)
I agree to the privacy policy.
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