Angels Among Us Application Form

Angels Among Us Application Ascension Parish

To ensure that all approved applicants are served, a government issued ID, copy of children's birth certificate are required. You must register and attach these required documents to this application.
Name of Applicant*

PrefixFirst NameMiddle NameLast Name
Applicants Birthdate*

MonthDayYear
Applicants Phone Number*

Area CodePhone Number
Applicants E-mail Address
Applicants photo Id

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Applicants Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child(ren) Info*
Income Eligibility Criteria

(To be eligible for The Angels Among Us Give-Away Program, you must complete the following)
Select which of the following you receive:*

MedicaidFood & Nutrition (EBT)Social Security Disability or SSI
Program Case or ID#
If you receive Social Security Disability or SSI, attach copy or upload a photo of your 2025 Award Letter.

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Copy of children's birth certificate*

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Copy of children's birth certificate

Browse Files

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Copy of children's birth certificate

Browse Files

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Copy of children's birth certificate

Browse Files

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Do you currently reside or have you resided in Ascension Parish within the past 30-days?*

YesNo
*Please Read Carefully

Heavens Care is proud to serve as a donation site for Angels Among Us. Each application is submitted as a request and therefore not guaranteed. All application decisions are granted at the sole discretion of Heavens Care and its partners. Please submit all required documents before the specified date so that your request will be processed in an efficient timeframe. Please fill out all required information so we can keep you updated on your application status. To ensure that all approved applicants are served, a government issued ID is required.

If you have any questions please leave it in the box below.
Comments or Questions:
Electronic Disclosure and Signature Agreement
- I know that any information given to The Angels Among Us Give-Away Program will be protected and kept confidential.
- I know that the information on this application is needed to determine eligibility for The Angels Among Us Give Away Program and/or my Income Eligibility Criteria or residential information will be checked against electronic databases at either the LA Dept. of Health and Human Services, or the Social Security Administration, or Ascension Parish Schools.
- By entering your name on the signature line, you are signing this Application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Application and is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You further agree that your electronic signature grants The Angels Among Us Give-Away Program the permission to confirm, where applicable, your income eligibility criteria, and or my child’s enrollment at Ascension Parish Schools, and or the residential information entered on this application.
Electronic Signature*
First and Last Name
DateTime
Should be Empty:

Angels Among Us Application Ascension Parish