Clone of SSF Sponsorship Application

Financial Assistance Application

This is a limited, one-time offering, is not designed for ongoing financial support, and is available on a first-come, first served basis. Please complete the form and we will contact you within 5 - 7 business days.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Home Address*
Date Hardship Began*
Have you received assistance from SSF within the last 12 calendar months?*

YesNo
I believe my situation is*

PermanentTemporary
What is your monthly household income*

Under $1,000$1,000 - $2000$2,000 - $3,000$4,000 or more
How many individuals reside in your household (please include total number of adults & children)*

12 - 34 - 78 or more
Type of Assistance Needed*

GasGroceryUtilitiesRent/MortgageOther
Please describe your hardship situation :*
Please check box the best explains your situation*

DivorcedBusiness failureUnemploymentIncome Reduction/UnderemploymentDeath of either primary or additional wage earner in the householdDisaster (natural or man made) adversely affecting your home or place of employment
Please list your monthly living expenses?*
How did you hear about Saved & Single Fellowship?*

Word of mouthFamily/FriendSocial MediaEventbriteWebsite
Should be Empty:

Financial Assistance Application