Secret Angels Assistance Request Form

Secret Angels Assistance Request Form
Thank you for reaching out to the Secret Angels. We are here to provide assistance and support during your time of need. Please fill out the following form to help us better understand your situation and requirements.
Name*

First NameLast Name
Please tell us a little bit about your current situation and why you are reaching out to the Secret Angels for help
Is there any additional information you would like to provide or any specific preferences regarding assistance?
Please let us know which one campaign would be beneficial to you at this time*

Financial Assistance (gift cards, food vouchers, etc.)Birthday WishesPack the PantryChristmas, Hanukkah & Other Special HolidaysWarm it Up:Blankets & Warm ClothingNew Moms BasketsAngel in the Sky Grief & LossTidy Haven OrganizingNew Year - Fresh StartHearts & Soles(Shoes, Boots & More)Sharing with the SeniorsHearts for the ArtsNew Immigrants Welcome PackageHomemade HappinessOther
Please explain why you need help with this specific campaign
Is there any additional information you would like to provide or any specific preferences regarding assistance?
Please share any additional important details including allergies, dietary restrictions and sensitivities
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth *

MonthDayYear
Date
Gender/ Pronoun
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Note: We appreciate your interest in seeking assistance from our organization. In order to ensure that we can provide meaningful support to as many individuals as possible, we have implemented a policy where applicants can select one campaign for assistance every 4 months. This allows us to allocate our resources effectively and extend our help to the broader community.

We understand that there is a great need, and we genuinely want to assist everyone who reaches out to us. However, our ability to help is contingent upon the resources available at any given time. Rest assured that our team is dedicated to making a positive impact and will do our best to support you within our means.

Thank you for your understanding and patience as we strive to support as many worthy causes as possible while ensuring the equitable allocation of resources.
Consent to Share Data: I consent to the sharing of my personal and household data with community groups that collaborate with Secret Angels for the purpose of providing assistance and support. I understand that this information will be used solely for the purpose of assisting me and my household.*

YesNo
Note: We value your privacy and assure you that your personal information will be handled with utmost care and confidentiality. It will only be shared for the purpose of providing assistance and support with relevant government and community groups when necessary to provide assistance.
Date

MonthDayYear
Date
Upon receiving your request, Secret Angels will respond to you in a timely manner. Your patience is appreciated as we work diligently to assist you. Thank you for reaching out to Secret Angels Group. Your request for assistance is important to us, and we will do our best to support you during this time.

Remember to check your email for responses!
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Secret Angels Assistance Request Form

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