Request for Help Form
Please complete the form for assistance.
Full Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What county do you live in?
How many people live in the household?
Please list everyone that lives in the home and ages.
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What do you need assistance with:
Utilities
Rent Assistance
Clothing/Shoes
Jackets/Coats/Blankets
Homelessness Assistance
Baby Items
Personal Hygiene
Food Assistance or Hot Meal
Youth Mentoring
Other
File Upload
Browse Files
Drag and drop files here
Choose a file
Upload your light bill, eviction notice, bills related to your situation.
Cancel
of
Signature
*
JLM Sack of Love is a volunteer-based assistance program funded entirely through the generosity of private donors, volunteers, and community supporters. We do not receive government funding; therefore, all assistance is dependent upon the availability of donated funds and resources and cannot be guaranteed. Requests for assistance are reviewed and prioritized based on the urgency of need, available resources, and our ability to provide support. While we are committed to helping as many individuals and families as possible, response times may take up to 72 hours, and we may not be able to fulfill every request. If we are unable to provide assistance, we will make every effort to connect you with other organizations or agencies that may be able to help. Applicants may request assistance up to two (2) times within a consecutive 12-month period. All personal information submitted to JLM Sack of Love will be kept confidential and will not be shared without your permission unless required by law. If assistance is provided, we ask that recipients submit a brief written testimony describing their experience. Any testimonials, photographs, or other identifying information will only be shared publicly with the recipient’s express consent. JLM Sack of Love is committed to serving our community with honesty, compassion, and integrity. If it is determined that false or misleading information was intentionally provided during the application process, we reserve the right to deny the request and determine eligibility for future assistance.
Submit Consent
Submit Consent
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