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 Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Home Address
*
Date Hardship Began
*
Have you received assistance from SSF within the last 12 calendar months?
*
Yes
No
I believe my situation is
*
Permanent
Temporary
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)
*
1
2 - 3
4 - 7
8 or more
Type of Assistance Needed
*
Gas
Grocery
Utilities
Rent/Mortgage
Other
Please describe your hardship situation :
*
Please check box the best explains your situation
*
Divorced
Business failure
Unemployment
Income Reduction/Underemployment
Death of either primary or additional wage earner in the household
Disaster (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 mouth
Family/Friend
Social Media
Eventbrite
Website
Submit
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