Furniture and Bed Request Form

Furniture and Bed Request Form
Please be aware that furniture vouchers are only given out during a scheduled home visit. Currently we only offer home visits on Tuesday mornings. If you are not available for a home-visit we will not be able to assist with a furniture voucher. We do not assistance with delivery, if we are able to help with a voucher, you will have to have a way to pick the up furniture on your own.*

Yes, I agree with these conditions
Do you currently live at the address, where the home visit would be completed?

YesNo
Name*

First NameLast Name
Current Address ( Please type HOMELESS if you do not have a residence yet)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Bed Delivery
At times we may be able to offer Bed Delivery. If this service becomes available, would you prefer bed delivery?*

NoYes (I do not have transportation)Yes (I have transportation)

Confirm the services you initially requested: (the request type must be the same as your initial selection.*

Furniture and BedsFurniture (only)Beds (only)Pack n Play (only)

Furniture and Bed Expectations
Please be aware that we cannot guarantee assistance with furniture. We consider requests for furniture every week. If we can assist with furniture, you will be contacted within a week to schedule a home visit. If you do not receive a phone call within a week to schedule a home visit, then this means we were not able to assist with the service for that week, but you are welcome to call back and reapply. If we are not able to reach you when calling to schedule a home visit, you will need to call back and reapply.*

I understand and agree to the statement above.

Pack n Play Expectations
You will receive a phone call from our team that assists with the Pack n Play Program within two weeks with details about the next steps.*

I understand the expectations above.

Bed Expectations
Please be aware that we cannot guarantee assistance with beds. If we can assist with a bed voucher, you will receive a text message within 7 business days. If you do not receive a text within that time, you can reapply through our website.*

I understand and agree to the statement above.

Infestation
We are limited in how often we can assist with furniture and beds, so your home must be treated before we can submit a request for a furniture or bed voucher. Once your home has been treated, please complete this form.*

I have read the statement above

New Address
We will not be able to accept a request for Furniture assistance until you have officially moved to a new residence. Please submit a request through our website at www.svdpcincinnati.org once you have moved to the new residence.

I have read the statement above

Please select the SUBMIT button below to send your request to our team for review. We can not guarantee assistance with furniture, beds or pack n play's. You will ONLY be contacted about the next steps if our team is able to assist. If you do not hear anything within a seven business days, you have the option to re-apply through this online request form.
Should be Empty:

Pack and Play Request