2025 Application for Financial Assistance

1

I live in...* This field is required.

Academy

Belton or Morgan's Point Resort

Holland

Temple

Harker Heights, Killeen, Nolanville, Rogers, or Troy

Outside Bell County, TX

2

Do you need assistance paying your electric bill?

YESNO

3

My electricity provider is...* This field is required.

TXU, Ambit, or TriEagle Energy

Reliant, Direct, Stream, Xoom, Green Mountain, Cirro Energy or Discount Power

Other

4

You must have a disconnect notice to receive assistance for these companies. Have you received a disconnect notice?* This field is required.

YESNO

5

Please enter your account number* This field is required.

6

Please apply for assistance when a disconnect notice is received.

7

Please upload your most current electricity bill.* This field is required.Bill(s) must clearly show YOUR name, address, and the most recent amount due

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8

Do you need assistance paying your water bill?

YESNO

9

Please upload your most current water bill.* This field is required.Bill(s) must clearly show YOUR name, address, and the most recent amount due

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Select files to upload

10

Do you need assistance paying your rent?

YESNO

11

Please upload your current lease.* This field is required.

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Select files to upload

Max. file size: 10.6MB

12

How much is your rent?* This field is required.

13

How much of your rent are you currently able to pay?* This field is required.

14

Do you need assistance paying your Atmos bill?

YESNO

15

Please upload your most recent Atmos bill.* This field is required.

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Select files to upload

Max. file size: 10.6MB

16

Helping Hands does not provide the assistance you need.

Please contact 211 to find more resources on assistance available in our area.

17

Tell us about yourself* This field is required.

First Name

Last Name

Date of Birth

Phone

Address

City

ZIP

18

What is your email address?

example@example.com

19

What is your preferred language?Your response to this question will NOT affect your ability to receive food or financial help at Helping Hands Ministry. We do not discriminate based on race, ethnicity, or language.

English

Spanish

Other

21

Does anyone living in your household receive any of the following assistance?* This field is required.

Medicaid

Free or Reduced School Lunch

SNAP (Food Stamps)

SSI (Supplemental Security Income) - This is NOT Social Security

TANF (Temporary Aid for Needy Families)

None of these

22

Does anyone in your household receive the following government benefits?* This field is required.

CHIP (Children's Health Insurance Plan)

Medicare (for older adults)

Social Security for the aged or disabled, or survivor's benefits

Veteran's Benefits

WIC (Women, Infants, and Children)

None of these

23

Does anyone in your household earn income from working?* This field is required.Only include income for household members age 18+.

YESNO

24

What is your current employment status?* This field is required.Proof of employment will be requested.

Working full-time

Working part-time

Unemployed

Retired

25

What is the total income for your household?* This field is required.Include income from ALL sources (employment, Social Security, SSI/SSDI, VA, child support, etc.)

$

Frequency

26

Please provide proof of income from all sources.* This field is required.Include income from ALL sources (employment, Social Security, SSI/SSDI, VA, child support, etc.)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

27

Please explain the unexpected crisis or loss of income that caused you to need assistance.* This field is required.

28

Please provide the following information to help us learn more about the community we serve.

Your responses will not affect your eligibility to receive assistance from Helping Hands Ministry of Belton.

29

How do you identify?Your response to this question will NOT affect your ability to receive food or financial help at Helping Hands Ministry. We do not discriminate based on sex or gender identity.

Female

Male

Other

Prefer not to answer

32

How many household members are Veterans?

0

1

2 or more

33

How many household members are active-duty military?

0

1

2 or more

34

How many household members are currently attending college?

0

1

2 or more

35

What is the highest level of education you have completed?

Did not complete high school or GED

High school graduate

GED

Some college

Associate's or Vocational degree

Bachelor's degree or higher

Prefer not to answer

36

What is your marital status?

Single, divorced, widowed, separated

Married, common law, domestic partner

Prefer not to answer

37

Are you a single parent or grandparent raising a child?

Yes

No

Prefer not to answer

38

Do you have a disability?

No

Yes, and it does not prevent me from working

Yes, and my disability prevents me from working

Prefer not to answer

39

Signature* This field is required.By signing this application, I certify that: 1) all information provided to Helping Hands Ministry of Belton to support this application for financial assistance is, to the best of my knowledge and belief, true and correct, to the best of my ability; 2) I agree to give Helping Hands Ministry of Belton permission to contact my employer, benefits provider, or creditors to verify the information I provided to establish my eligibility; 3) I agree to give Helping Hands Ministry of Belton any additional information it needs to prove any statement or determine my eligibility; 4) I understand as a condition of approval for financial assistance I may be required to participate in a class or classes, case management, or other program(s); 5) I understand this application will be considered without regard to race, color, religion, creed, national origin, or political belief; 6) I understand if I am granted financial assistance I may be ineligible to receive financial assistance from Helping Hands Ministry of Belton in the future; 7) I understand this is not an application to use the Food Pantry at Helping Hands Ministry, and I am welcome to apply to use the Food Pantry using a separate application.

Electronic Signature

40

Today's Date* This field is required.

Date

41

We will follow up via email, so keep an eye out! All eligible Texas residents are welcome to use our food pantry.Please call 254-939-7355 to see if you qualify.