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Assistance

ASSISTANCE

If you are in need of assistance please fill out the following form. The board of directors will review each application and will contact you on the status.

“And my God will meet all your needs according to the riches of his glory in Christ Jesus.”
Philippians 4:19

Assistance Application Form


Contact Information


Personal Information

Date of Birth:

Gender:





Household Information

Is there a spouse/other guardians living in household?




Other Individuals living in household

1. Date of Birth:

Gender:

2. Date of Birth:

Gender:

3. Date of Birth:

Gender:

4. Date of Birth:

Gender:

5. Date of Birth:

Gender:

6. Date of Birth:

Gender:

7. Date of Birth:

Gender:

8. Date of Birth:

Gender:

9. Date of Birth:

Gender:

10. Date of Birth:

Gender:



Assistance Request


Special Need Requesting:

Purpose of Request:

Have you received assistance previously from Four Winds Ministries?

If YES, When/What?

Have you contacted anyone else for assistance in the last twelve months?

If YES, Who/What?


References




Terms

I authorize Four Winds Ministries to verify all information provided.

I AGREE



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