Helping Others, Help Themselves Application
The Ricky Davis Legacy Foundation
Today's Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Annual yearly income
$0-5,000
$5,000-10,000
$10,000-25,000
$25,000-36,000
$36,000-60,000
$60,000-100,000
Types of Assistance Needed
*
Household Items
Clothing Items- Men, Women, and Children
Financial Assistance
Is this your first time requesting assistance?
*
Yes
No
Have you received a voucher from our organization before?
*
Yes
No
Please provide month, day, and year of granted voucher
-
Month
-
Day
Year
Approved date or estimated date
Number of Members in your household
Total of Members
Household Member #1
First Name
Last Name
Household Member #2
First Name
Last Name
Household Member #3
First Name
Last Name
Household Member #4
First Name
Last Name
Household Member #5
First Name
Last Name
Please provide a brief summary of why you are in need of assistance.
Submit
Should be Empty: