Request for Assistance Application

Request for Assistance Application

“Providing groceries. Restoring dignity. Sharing the love of Christ."
Section 1

Applicant Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*

PikeSciotoRoss
In which Ohio County do you live?
Rhema of Hope is only currently serving families in Southern Ohio
Section 2

Household Details
Total number of people in your household?*
Number of related adults (18 and older)*
Relation is by marriage, blood, or adoption
Number of non-related adults (18 and older)
Non-Related adults
Number of related children in household (Under 18)
Relation is by marriage, blood, adoption, foster children
Number of non-related children in household (Under 18)
Non-Related Children
Please list the name, age, and gender of all children.
Please list the names, ages, and gender of all children who lives in the household either full-time or part-time
Section 3

Current Situation
Please briefly describe your current situation and why you are seeking assistance (e.g., job loss, medical hardship, single-parent household, financial crisis, etc.):
Reason for Request:
Section 4

Additional Information
The following questions are for informational purposes only and will not affect your eligibility. Your answers help us serve you better.
Are you currently connected to a church?

YesNo
Would you be open to prayer or spiritual encouragement form a Rhema of Hope trained volunteer?

YesNoMaybeType option 4
Would you be interested in learning about other support or discipleship opportunities through Rhema of Hope?

YesNoMaybe
Section 5

Certification and Consent
By signing below, I certify that the information I have provided is true to the best of my knowledge. I understand that submitting this application does not guarantee assistance, and I give permission for a representative of The Joseph Project to contact me regarding this application.
Signature

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Request for Assistance Application

Section 1

Section 2

Section 3

Section 4

Section 5