Financial Assistance Application

Clothing is given by appointment Monday-Thursday from 9:00AM-1:00PM or by walk-in Friday from 9:00AM-1:00PM (the last person is accepted into the Clothing Closet at 12:30PM). You are eligible to shop in our Clothing Closet once every 90 days.

Please note that due to limited funding we are only able to assist with a small portion of your bill, and our pledge is only for the last amount due. For example, if you owe $300, we may be able to assist with the last $100 after you have paid the first $200.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.  Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits.  Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992.  Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture: Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. This institution is an equal opportunity provider.

The White Rock Center of Hope is a volunteer driven non-profit ecumenical organization dedicated to making a difference in people's lives by providing a place where the community works together to share God's love and blessings by satisfying their neighbor's basic human needs.  As an applicant for emergency assistance, you certify that all of the information you provided on this form is true, complete, and correct and that all income is reported. “White Rock Center of Hope (WRCH) has my permission to exchange information, verbally, in writing, electronically or otherwise, regarding my circumstances with any concerned agency or individual. I authorize WRCH to collect any documentation necessary from third party payees that may be required for WRCH to be reimbursed by its funding organizations.” For individuals participating in activities funded by government grants including the Emergency Shelter Grant Program, your signature indicates, “I understand that this information is given so that WRCH can receive Federal funds from the Department of Housing and Urban Development. I understand that the information I have provided can be verified by the White Rock Center of Hope, or by HUD and that deliberate misrepresentation of this information may subject me to prosecution under applicable state and federal law.” Food and clothing received are in "as is" condition. No warranty of any kind is being made, give, or implied.