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Sparrow's Nest Application for Assistance
Please read below before completing application. WE HAVE USED OUR FUNDS FOR THIS MONTH, BUT YOU MAY APPLY & WE WILL REACH OUT TO YOU WHEN MORE FUNDS ARE AVAILABLE.
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 normal household bills. Financial aid may include assistance with power or water bills and the cost of medications for those living in Glynn and McIntosh Counties. We are unable to help with rent, mortgage payments or hotel expenses. We can only assist one time every 12 months.
Examples of qualifying emergencies include:
•Recent Serious Illness •Hospitalization or Surgery •Death in the immediate family that caused you financial hardship •Major car repair •Fire or Accident •Water Leak or Major Home Repair
How do I qualify?
If you have had a recent emergency expense that has caused you to be unable to pay your utility bill or purchase your medications, you may qualify. You need to have normal monthly household income to qualify for assistance. You must have been employed 3 of the last 6 months or have been receiving disability or social security benefits during this time. You must also be able to document the emergency expense with paperwork. This documentation may be hospital discharge papers, repair receipt, doctor note showing work absences, etc. Upon receipt of your application, we will be in contact with you within 5 business days. 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) 264-3281 • Salvation Army - (912) 265-9381 • St. Vincent de Paul (912) 262-6027
Job Loss or a reduction in work hours does not meet our qualifications for assistance unless related to serious illness or other emergency circumstance (layoff, store closure, etc).
Contact 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
Do you have children 18 or under living with you?
*
Yes
No
If you have children living at home, please list first names and birthdates.
Have you received financial assistance from the Sparrow's Nest in the past 12 months? (If Yes, we cannot help you again at this time)
*
Yes
No
Which County do you live in? (we can only assist those living in these counties)
*
Glynn
McIntosh
Recent Emergency Details
Please check what applies to your current emergency
*
Hospitalization or Surgery
Recent Serious Illness
Death in Immediate Family Causing you Financial Hardship
Fire or Accident
Water Leak
Major Car Repair
Major Home Repair
Other
Please explain why you are in need of assistance and how this recent emergency has impacted your monthly cash flow and ability to pay your bill.
*
Please upload your documentation of the recent emergency you have described above. This could include: hospital discharge papers, doctor excuse for work, repair receipts, burial expense receipts, etc. (We will not accept any applications without documents to support your recent emergency. )
*
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What type of bill do you need help with?
What type of assistance do you need? (Select only 1)
*
Power Bill
Water Bill
Gas Bill
Medication Cost
Only complete information for the bill you are applying for
Water/Sewer Provider Company Name
Water / Sewer account number
What is the amount due?
Are you on a payment plan?
Yes
No
Is your water or disconnected?
yes
No
Upload a copy of your water/sewer bill.
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Electricity Or Gas Company Name
Electricity or Gas Account Number
Is this a prepay account?
Yes
No
What is the amount due?
Is your power or gas turned off?
yes
No
Please upload a copy of your electricity or gas bill.
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Name of Pharmacy? (only complete if requesting help with medications)
Pharmacy phone number?
Who is the prescription for?
What is the cost of the prescription?
Please upload a copy of your prescription.
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Employment & Income Information
You need to have normal monthly household income to qualify for assistance. You must have been employed 3 of the last 6 months or have been receiving disability or social security benefits during this time and be able to provide proof of income, pay stubs, or a separation notice.
Are you currently employed?
*
Yes
No
Current Employer
How long have you been employed there?
Total monthly income from Job?
If currently unemployed, what was your last day of employment?
If currently unemployed, where was the last place you worked?
How long did you work there?
If unemployed, explain the reason for your job loss.
Upload a Copy of your 3 most recent Pay Stubs, Proof of Income (social security, disability) OR separation notice if unemployed:
*
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How much do you make a month from benefits?
Social Security Benefits:
Disability Benefits:
Child Support:
Alimony:
Food Stamps:
WIC:
Other Assistance:
What are your current monthly expenses?
Rent/Mortgage
*
Electricity
*
Water
*
Car
*
Childcare
*
Other
Do we have permission to contact your utility provider / pharmacy on your behalf?
*
Yes
No
We will contact you within 5 business days after receiving your application. Incomplete applications WILL NOT BE REVIEWED
Type your name below to certify all information is true and correct
*
Submit
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