NBOMNFL Application for Assistance

NBOMFL Ministry cares about the welfare of others and offers assistance with meeting the emergency needs of an individual or family. We offer help with rent, utilities, transportation, medical expenses, groceries, and other necessities. We provide wisdom, direction, and guidance. If you are in need of assistance, please fill this form out as completely as possible. This is a necessary step to give you access to our resources. Once You Complete this form you will be contacted at the info you provide for an interview. After the interview we will offer what we can to assist you.

Your Name*

List Here the Phone Number You Prefer to Be Texted At*

If you have a second Phone number or a phone number you prefer to be called at, List it here

Your Email address*

example@example.com

Please list your social media handles here such as Facebook, Instagram, Linked In or other. If none, list none.*

Street number and Name of Street*

City, State and Zipcode*

Your Previous -Street Name and Number*

City, State and Zipcode*

Marital Status and Name of Spouse (if Applicable)*

List All Who You Are Living With Now:*

RENT: Who do you pay rent to and Amount of Rent monthly*

Are you currently in a relationship with someone ? Yes or No? (This does not include family members)*

List Here (If Applicable )The names and ages of your Children. Include the Address and With Whom your children live.*

List here the names, addresses and phone numbers of friends and family that are supportive to you at this time. If none, list none.

What type of transportation do you have? *

If Applicable and you have a car to drive, Is your car insured?

NoYes

If applicable vehicle Tag Number

Please Report any Employment, Personal, Government, Federal Assistance, Any form of financial help that you have right now. (including child support)

Source of Income, How much and How Often Do Receive Income? Is it Monthly or Bi-Monthly or Other?*

Do You Have Child Support and If Yes, Who Pays It?*

Please list any medical conditions that you may need help with.

Do you feel you could use SPIRITUAL support? If yes, please share what you feel could help.

Do you feel you could use EMOTIONAL support? If yes, please share what you feel could help.

Please list here any church or support groups that you have available to help you.

Please share here Any Additional Information You Feel We should Know

Please Share Your needs and How You Feel Nobmfl can help you.

I AFFIRM THAT ALL THE INFORMATION IS THE TRUTH, AND I GIVE MY PERMISSION TO HAVE ALL INFORMATION CONFIRMED INCLUDING A BACKGROUND CHECK

Signature*

Date*

Date

Share Your Social Security Number

CURRENT LIVING CONDITIONS:

INCOME