Level Up Application
Level Up is a partnership of City of Moline and Project NOW to provide assistance (either ongoing or one-time) to residents of Moline. We are looking to assist 181 Moline households during the 2025 calendar year. Thirty-one households will be accepted to an ongoing assistance program that will be required to meet monthly and work with a Project NOW Case Worker. 150 households will receive one-time assistance for needs such as rent, utilities, drivers license fees, emergency housing maintenance (sewer back ups, leaks, furnace repair/replacement. etc.), emergency transportation issues (car repairs, bus tickets), and other emergency needs. This program is offered to Moline residents only.
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
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Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Social Security Number
*
Please list everyone that lives with you.
Educational Program Information
You are not required to be enrolled in an educational program to receive assistance. Those seeking one-time assistance may skip this section.
Are you currently enrolled in an educational program at a college or university, Unity Point or University of Illinois Nursing Programs, in a local apprenticeship in a trade organization, or other secondary educational program. This can be either In-person, online, or hybrid.
Yes
No
Where are you currently enrolled?
Household Income
What is your household's past 30-day income? (You will be required to upload these documents at the end of this application. If you do not have access to these documents please stop and resubmit once you do).
*
For one-time assistance, please describe your emergency assistance needs. (Funds are subject to one issue for the life of the program. All payments will be made directly to vendors and not to the applicant).
How much assistance do you need?
*
Who is your vendor/landlord?
*
Please provide contact information for the vendor/landlord.
*
Please upload your photo ID. NOTE: if the address on your ID is not correct please upload a utility bill or lease to show current address.
*
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of
Please upload your household's social security cards.
*
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Please upload income for the past 30 days.
*
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Please upload proof of enrollment in a secondary school. NOTE: if seeking one-time assistance, skip this step.
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Please upload any other document to show the need for emergency assistance. Project NOW reserves the right to request further documentation at a later time.
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Signature
*
Submit
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