How Can We Help You
Please take the time to outline in detail what we can possibly help with and our team will read it over. Even if you filled out the previous form for the months prior, please refill this out for the month of April. This is all completely free, because our goal is to help you.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
In case we need to contact you.
Address - In Case We Visit You
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Can We Help You With?
*
Example: Tuition, Transportation, Medical, Homelessness, Teacher, Facility Help Rent, Groceries etc.
Tell Us More On How We Can Help
*
Be as detailed as possible, we would love to hear your story! Not everyone will be chosen, but we will keep all submissions in case we help months down the line.
Estimate of Your Assistance Needs
Please use this section to provide an estimate of the support you need from Gold Hearted.
Send Us A Video Sharing Your Story
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Choose a file
We believe in the power of personal stories. By uploading a video, you have the opportunity to share your unique journey, your voice, and the essence of your experience. Your video will help us better understand your story, your needs, and the impact of our support.
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