Helping Hands Application

The Helping Hands Ministry assist individuals with short term financial needs. We help with utilities only (no rent). Guidelines we use include a maximum assistance amount that is set from time to time by the governing body of the church. Please complete all sections of this application and attach a copy of your photo ID (Driver's License) and the bill(s) you are submitting for assistance.

Name *

Address *

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Email *

Mobile Phone *

Is this your primary address? *

Yes

How long have you lived at this address? *

If the address on your ID does not match the address above, please explain

What is your monthly income? *

Do you expect this income to continue in the foreseeable future? If not, please explain. *

Please state the amount and purpose of the assistance you are seeking. *

What caused this need? *

How did you learn about Helping Hands? *

Have we assisted you previously? *

Yes

Please list other agencies where you have applied for assistance. *

Are you a member or regular visitor of Dardenne Presbyterian Church? *

Yes

Are you interested in learning more about Dardenne Presbyterian Church? If yes, someone from the church will contact you. *

Yes

Please attach a photocopy of the utility bill here. (Note this field only accepts one attachment). If you are submitting a second bill, attach it below. *

Attach photocopy of additional bill here, if applicable.

Attach a photocopy of your Photo ID here: *

By checking the box below you acknowledge: (1) The information provided is for the purpose of assessing my need for utility assistance and, (2) All informationwill be treated in a moral, ethical and confidential manner and (3) Submitting this form does not guarantee I will receive assistance. *

Acknowledged

Date *

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Helping Hands Application