Application intake form
Use the form below to submit a request for emergency assistance review. After submitting, you will receive a reference ID to track your application status.
Before submitting
- Use your full legal name
- Provide a working email address
- Enter a phone number where you can be reached
- Describe your situation clearly and briefly
- Submit only one request per situation
A reference number will be generated automatically after submission.
JIT-EX assistance intake
If the embedded form does not load properly on your device, open the application in a separate tab using the button below.
After submitting the form, a reference ID will be created automatically and emailed to you.
Submitting an intake request does not guarantee approval, eligibility, or payment.
1
Submit Request
Complete the intake form with your contact details and situation.
2
Review Process
Your request may be reviewed and supporting information may be requested.
3
Status Updates
Track your application using your reference ID on the status page.
Service area
The JIT-EX intake portal currently serves residents located within Cook County, Illinois. Applications submitted from outside the service area may not be processed.
Use the status page to monitor updates related to your application.