Thanksgiving Dinner Basket

Rhema Word Foundation (aka) Rhema Wings

To ensure that all approved applicants are served, a government issued ID must be provided at the time of pick-up. If you are unable to pick-up your Thanksgiving dinner basket, please include a name and phone number, in this form, of the person picking up your basket. Also, they must bring their government issued ID. You must register by September 30, 2023 and bring your required ID with you on the pickup day. The Thanksgiving dinner basket Pick Up location will be announced at a later date. Please check your email and SPAM folder for updates..
Thanksgiving Dinner Basket

Holiday Help Program
THIS THANKSGIVING SIGNUP IS FOR FAYETTE COUNTY ONLY. (If you do not live in Fayette County, please reach out to your county's food banks and/or food programs)*

Yes, I reside in Fayette County.No, I do not reside in Fayette County. (If you are not a resident of Fayette County, please do not complete this form)I'm signing up a relative who resides in Fayette County.
Name of Applicant*

PrefixFirst NameMiddle NameLast Name
Applicants Birthdate*

MonthDayYear
Applicants Phone Number*

Area CodePhone Number
Applicants E-mail Address
example@example.com
Applicants photo ID
Pre-Submit (optional)
Applicants Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you currently employed?*
Where do you work?
What is your monthly income?
Are there any other adults (18 years and older) in the home? If so, how many? Please list name(s) and date of birth.
First Name Last Name Date of Birth
First Name Last Name Date of birth
Child(ren) Info
Name of pick-up person: (must bring ID to pick-up basket)
How are they related to you? fields and text.
Income Eligibility Criteria

(To be eligible for The Thanksgiving Dinner Basket, you must complete the following)
Select which of the following you receive:*

Medicaid/MedicareFood & Nutrition (EBT/SNAP)Social Security Disability or SSIUnemploymentSingle ParentAbuse SurvivorIndependent Senior CitizenNone of the above
Program Case or ID#
If applicable
Are you a victim of abuse and need assistance?*

YesNo
*Please Read Carefully

The Rhema Word Foundation is proud to serve as a donation site for survivors of adult and child abuse, single parents, and senior citizens with nutritional, counseling, and financial resources and has partnered with Lighthouse Ministries, and God's Pantry to make this Holiday Help program a success.

Each application is submitted as a request and therefore not guaranteed. All application decisions are granted at the sole discretion of the Rhema Word Foundation and its partners. Please submit all required documents before the specified date so that your request will be processed in an efficient timeframe. Please fill out all the required information so we can keep you updated on your application status. To ensure that all approved applicants are served, a government-issued ID is required.

If you have any questions please leave them in the box below.
Comments or Questions:
Electronic Disclosure and Signature Agreement
- I know that any information given to The Rhema Word Foundation (aka) Rhema Wings will be protected and kept confidential.
- I know that the information on this application is needed to determine eligibility for The Thanksgiving Dinner Basket Program and/or my Income Eligibility Criteria.
- By entering your name on the signature line, you are signing this Application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Application and is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You further agree that your electronic signature grants The Rhema Word Foundation (aka) Rhema Wings the permission to confirm, where applicable (if necessary), your income eligibility criteria, entered on this application.
Electronic Signature*
First and Last Name
DateTime
Should be Empty:

Rhema Word Foundation (aka) Rhema Wings

Thanksgiving Dinner Basket