Sparrow's Nest Application for Assistance

Sparrow's Nest Application for Assistance

Please read below before completing application.
Although we would like to help all who are in need, we can only offer financial aid to clients who have recently experienced an emergency that has caused them to be unable to pay their bills. Financial aid may include assistance with power or water bills and the cost of medications. We cannot help pay rent, mortgage payments or utility deposits. If we have helped you within the past year we cannot help you at this time.
We can only assist one time per year.
Examples of qualifying emergencies include:

•Illness •Hospitalization •Death in the immediate family that caused you financial hardship •Major car repair •Fire •Theft
I you have had such an emergency and can document it with doctor bills, etc. please complete this application. A staff member will be in contact with you after you submit your application. If you have questions please contact Sabra Slade at sabra@faithworksministry.org
Other organizations that may be able to help you include:

• Coastal Community Action Authority - (912) 261-9071 • Salvation Army - (912) 265-9381 • St. Vincent de Paul (912) 262-6244
Loss of job or a reduction in work hours does not meet our qualifications for assistance unless it is COVID-19 related. If it is COVID-19 related please fill out our COVID-19 Application for Assistance at the link below. https://faithworksministry.org/assistance/
Basic Information
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
E-mail
example@example.com
Date of Birth *

Month Day Year
Date
Have you received financial assistance from the Sparrow's Nest in the past 12 months? *

Yes No
Upload a copy of your photo ID *

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Cancel of
Assistance
What type of assistance do you need? *

Power Bill Water Bill Medication Cost
Do we have permission to contact your utility provider or pharmacy on your behalf? *

Yes No
Which circumstance is your assistance need related to? *

Hospitalization Recent Serious Illness Death in Immediate Family Fire Theft Flood
Please explain your circumstances and why you are in need of assistance. *
Please upload your documentation of a recent emergency. (Written documentation is required to qualify for assistance.) *

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Cancel of
Account Details
Please fill in the information below.

(you only need to fill in the information that applies to the type of assistance you are applying for)
JWSC Water / Sewer account number
What is the amount due?
Are you on a payment plan?

Yes No
Is your water disconnected?

yes No
Upload a copy of your water/sewer bill.

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Cancel of
Electricity Provider's Name
Your Electricity Provider Account Number
Is this a prepay account?

Yes No
What is the amount due?
Is your power turned off?

yes No
Please upload a copy of you electricity bill.

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Cancel of
Name of Pharmacy?
Pharmacy phone number?
Who is the prescription for?
What is the cost of the prescription?
Employment & Income Information
Current Employer *
Total monthly income from Job?
How long have you been employer there?
Upload a Copy of your Pay Stubs

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Cancel of
List all monthly benefits and assistance received
Social Security:
Disability:
Child Support:
Alimony:
Food Stamps:
WIC:
Other Assistance:
I certify that all of the above information I have provided is true and correct:
Signature *

Clear
Should be Empty:

Sparrow's Nest Application for Assistance

We can only assist one time per year.

Examples of qualifying emergencies include:

Other organizations that may be able to help you include:

Loss of job or a reduction in work hours does not meet our qualifications for assistance unless it is COVID-19 related. If it is COVID-19 related please fill out our COVID-19 Application for Assistance at the link below. https://faithworksministry.org/assistance/

Basic Information

Assistance

Account Details

Please fill in the information below.

Employment & Income Information

List all monthly benefits and assistance received