Sacred Heart The Society of St. Vincent de Paul Assistance Request

Sacred Heart - The Society of St. Vincent de Paul - Assistance Request

Thank you for contacting the Society of St. Vincent de Paul for assistance. Please review the eligibility requirements below before completing this form.
Please review the information below carefully before starting your request.
Eligibility Requirements

The Sacred Heart Conference serves: Registered parishioners of Sacred Heart Catholic Church on Perry Street, OR Individuals residing in zip codes 23224 and 23234. If you reside in another zip code, please reference the footer of our website to see if another conference services your area. If our conference is able to provide assistance, the maximum amount we can contribute is $700 per household. If your outstanding rent balance exceeds $1,000, please wait until the balance is reduced to $1,000 or less before submitting a request, as we cannot provide assistance until you are near $700. For any other bills (i.e., Dominion Energy, water bill), you may submit a request at any amount and our conference will confirm if a progress payment can be made. Please note, we cannot cover hotel bills. Please provide all requested information as completely and accurately as possible. Incomplete or inaccurate information may delay the review of your request. After your form is submitted, a member of our conference will contact you by phone to discuss next steps and any additional information that may be needed. We will review your request as promptly as possible.
First Name
Last Name(s)
Phone Number
Please share the phone number that is the best number to contact you.
What type of phone is the number you shared above?
Email
Please share the email that is the best email to contact you.
Are you a parishioner at Sacred Heart Catholic Church on Perry Street?
Do you currently have housing?

Temporary Housing
Which zip code did you previously live in?
Can you please share your current housing situation?
For example, are you staying at a hotel or family/friend's house?

Home Address
Street Address
City
State
Zip Code

Parishioner Zip Code
What is the zip code of your current housing or if you are unhoused, what is the zip code of your previous residence?

Household Members

Please complete the following set of questions for all members of your household.
Household Member #1
What is this member's relationship to you? (#1)
First Name (#1)
Last Name(s) (#1)
Date of Birth (#1)

MonthDayYear
Date
Household Member #2

Please leave blank if you have no further household members.
What is this member's relationship to you? (#2)
First Name (#2)
Last Name(s) (#2)
Date of Birth (#2)

MonthDayYear
Date
Household Member #3

Please leave blank if you have no further household members.
What is this member's relationship to you? (#3)
First Name (#3)
Last Name(s) (#3)
Date of Birth (#3)

MonthDayYear
Date
Household Member #4

Please leave blank if you have no further household members.
What is this member's relationship to you? (#4)
First Name (#4)
Last Name(s) (#4)
Date of Birth (#4)

MonthDayYear
Date
Household Member #5

Please leave blank if you have no further household members.
What is this member's relationship to you? (#5)
First Name (#5)
Last Name(s) (#5)
Date of Birth (#5)

MonthDayYear
Date
Household Member #6

Please leave blank if you have no further household members.
What is this member's relationship to you? (#6)
First Name (#6)
Last Name(s) (#6)
Date of Birth (#6)

MonthDayYear
Date
Household Member #7

Please leave blank if you have no further household members.
What is this member's relationship to you? (#7)
First Name (#7)
Last Name(s) (#7)
Date of Birth (#7)

MonthDayYear
Date
Household Member #8

Please leave blank if you have no further household members.
What is this member's relationship to you? (#8)
First Name (#8)
Last Name(s) (#8)
Date of Birth (#8)

MonthDayYear
Date
Household Member #9

Please leave blank if you have no further household members.
What is this member's relationship to you? (#9)
First Name (#9)
Last Name(s) (#9)
Date of Birth (#9)

MonthDayYear
Date
Household Member #10

Please leave blank if you have no further household members.
What is this member's relationship to you? (#10)
First Name (#10)
Last Name(s) (#10)
Date of Birth (#10)

MonthDayYear
Date
Do you have any other household members to add?

Assistance Request
Please share what you need assistance with

Other
What person/organization needs to receive payment?
How much is owed?
When is/was the bill due?
Are there any urgent dates we should know about?
For example, do you have an eviction date, a court date, or a date when a utility will be cut off if payment isn't received?
Please upload a file(s) that shows the current amount due and the name and address of the recipient/organization that will receive payment.

For example, if you are requesting with a utility expense, please upload a photo or PDF of the bill. If you are requesting assistance with a rental payment, please upload a photo or PDF that shows the amount you currently owe.
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If other organizations are contributing to payment of the bill that will allow you to qualify for our assistance requirements, please share the organizations and their contributions here.
Please remember that for all rental assistance requests, we are unable to consider applications for bills over $1,000 unless you have confirmed assistance from other organizations that will reduce the remaining balance to under $1,000.
If other organizations are contributing to payment of the bill, please share documentation of the organizations and their contributions here.

If you answered yes to this question above, you must upload documentation here to have a completed application.
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Are there any other details or context you'd like to share about your assistance request?
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Sacred Heart - The Society of St. Vincent de Paul - Assistance Request

Eligibility Requirements

Temporary Housing

Home Address

Parishioner Zip Code

Demographic Info

Household Members

Household Member #1

Household Member #2

Household Member #3

Household Member #4

Household Member #5

Household Member #6

Household Member #7

Household Member #8

Household Member #9

Household Member #10

Assistance Request