If you are a resident of St. Joseph County, Indiana and are in need of clothing & miscellaneous certificates, please fill out each section of this form. 

 IMPORTANT - PLEASE READ

You will need to scan your documents to complete the application, EVEN IF WE HAVE HELPED YOU BEFORE. 

Before you begin your application - scan or take a clear picture of the following documents.  You will upload these at the end of the application

If you do not have your documents, or you only submit partial documents, your application will be denied and you will have to reapply.

If you do not have a computer or have any problems with these documents, go to any branch of your South Bend Public Library and ask a librarian for help filling out the application.  They are ready and willing to help you!!.

Identification & Income Required Documents:

1. Photo ID for EVERY adult (over 18) living in the home
2. Birth Certificate or Social Security Card for each child (17 and younger)
3. Proof of current address
   • Current lease or a piece of mail with your address on it - utility bill, etc.

I understand that the St. Vincent de Paul Society of St. Joseph County, Inc. (SVDP), may need to obtain and/or share information about me to establish my eligibility for services such as client choice pantry, home food delivery, food and clothing vouchers, rent and utility assistance, and any other SVDP program for which I apply.  I also understand that SVDP may obtain and/or share information about me through written, oral, and electronic communication.

By submitting this form:

• I authorize SVDP to obtain information about me from other agencies, organizations, and individuals for the limited purpose of making decisions about my eligibility for and participation in one or more SVDP programs.
  
  
• I authorize SVDP to share information about me from other agencies, organizations, and individuals for the limited purpose of making decisions about my eligibility for and participation in one or more SVDP programs.
  
  
• I understand that my authorization will remain effective from the date I sign below until I withdraw this authorization in writing.
  
  
• I understand that I may withdraw this authorization at any time by delivering a written notice to the Executive Director of SVDP, and that my withdrawal will be effective when SVDP receives it.
  
  
• I understand that SVDP will handle my personal information in compliance with all applicable laws.