Watts of Love Charitable Service Application
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many people live in your home?
Please Select
1
2
3
4
5
6
7+
What is your estimated total household income (per year)?
Please Select
Under $15,000
$15,000 – $25,000
$25,000 – $35,000
$35,000 – $45,000
$45,000 – $55,000
Over $55,000
Prefer not to say
Do you currently receive any of the following?
SNAP / EBT
Medicaid
SSI / SSDI
Section 8 or Housing Assistance
Unemployment
None of the above
Brief Explanation
Proof of Financial Need
Browse Files
Drag and drop files here
Choose a file
common documents people can easily upload or snap a photo of:💰 Recent pay stub showing low income, W-2 or 1040 tax return (just the part showing annual income), Letter from employer indicating part-time or reduced wages 📄 SNAP / EBT card (photo of front), Medicaid card, Section 8 housing voucher letter, SSI or SSDI award letter, Unemployment benefits letter🧑⚕️ Letter from a social worker, church leader, nonprofit, or shelter. Proof of disability or medical hardship. Eviction or utility shut-off notice
Cancel
of
I understand that submitting this form does not guarantee service and that all information will be kept confidential.
Submit
Should be Empty: