NGL

Application for Assistance

This form must be completed in one session. By pressing the SUBMIT button at the end of the page, the form's information will be sent to No Greater Love Community Services and to an email address you provide below.

Type of Assistance

(check all that apply)

General Assistance
Back-To-School
Thanksgiving Assistance
Christmas Assistance

Client Information

First Name

Last Name

Street Address

City

State

County

Zip

Phone#

D.O.B

Last 4 SSN

# Adults

# Children

Govt ID?

Email

Children's Names

(We cannot guarantee assistance for children over the age of 12. Add additional children in the notes area below. If on a smart phone scroll left to add age, sex, sizes, and gift wish.)

';

Name of Child	Age	Sex	Clothing Size	Gift Wish Request

Monthly

Income

Employment ($)
Social Security ($)
SS Disability ($)
Child Support ($)
Transitional Asst ($)
Unemployment ($)
Food Stamps ($)
Other ($)

Expenses

Rent/Mortgage ($)
Electric ($)
Gas/Oil ($)
Cable ($)
Phone ($)
Car Payments ($)
Car Insurance ($)
Other ($)

Notes:

I certify that the information is complete and true to the best of my knowledge and belief.