Salvation Army - Financial Assistance Application through Join Hands Ministry

Please fully fill out this application according to your need. If you are requesting financial assistance that is more than $200, you must complete the Join Hands Ministry Financial Assistance Application here. After submitting the form, our team will review your application and contact you to set up a meeting. Please note any application received outside of Join Hands Ministry's operating hours will be processed the next business day.

All information shared on this form will remain confidential within Join Hands Ministry and Salvation Army. If another organization may be able to better help you, we will not share your information without your permission.
NOTE:

Salvation Army funds are only able to help individuals and families living in Perry County (Pennsylvania) one time per 365 days. We will require ID for proof of residency. If the address on the application doesn't match the address on your ID, you must upload a yellow card with your new address with the ID. For additional information regarding this application, please call the office at 717-582-7844 or email info@joinhandspa.com.

Salvation Army - Financial Assistance Application
YesNo
Unfortunately, based on the requirements of these funds, the Salvation Army, through Join Hands Ministry, is only able to provide services to residents of Perry County, Pennsylvania.

We encourage you to contact the Salvation Army chapter in your county of residence to learn more about assistance that may be available to you.
Upload Current Pennsylvania Driver's License or Pennsylvania ID*

If the address on your current driver's license or Pennsylvania ID does not match the address on this application please include the yellow change of address card.
Cancelof
YesNoI do not know
The amount you are requesting is more than allocated through this program. Please complete the Join Hands Ministry Financial Application here.
Please complete the Join Hands Ministry Financial Application here.

Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (best number to reach you)*
Format: (000) 000-0000.
Email*
example@example.com
YesNo, I live alone

Household Member (other than applicant)*

First NameLast Name
Birthdate*

MonthDayYear
Date
Relationship to Applicant*
School (if member is a child)
Other information.
Add additional household member(s)

Household Member

First NameLast Name
Birthdate

MonthDayYear
Date
Relationship to Applicant
School (if member is a child)
Other Information
Add additional household member(s)

Household Member

First NameLast Name
Birthdate

MonthDayYear
Date
Relationship to Applicant
School (if member is child)
Other Information
Add additional household member(s)

Household Member

First NameLast Name
Birthdate

MonthDayYear
Date
Relationship to Applicant
School (if member is a child)
Other Information
Add additional household member(s)

Household Member

First NameLast Name
Birthdate

MonthDayYear
Date
Relationship to Applicant
School (if member is a child)
Other Information
Add additional household member(s)

Household Member

First NameLast Name
Birthdate

MonthDayYear
Date
Relationship to Applicant
School (if member is a child)
Other Information

Disclaimer, Client Consent, & Signature:

I hereby authorize the release of information to Join Hands Ministry to receive assistance I am requesting. I further certify the information I have provided is true and correct and that if requested, all income and expenses have been reported. I understand that Join Hands Ministry may verify the information on the application and any deliberate misrepresentation of information will be subject to denial of assistance and services. I authorize Join Hands Ministry to discuss my case with other agencies (list of partnering agencies), businesses, churches, attorneys, individuals or others deemed necessary to verify the accuracy of information and/or identify additional sources of assistance. I understand that all information will remain as confidential as possible within these entities. I have read, understand and agree to the policies above regarding the Release of Information.
By typing your full name in the box below, you are providing your signature and acknowledging that you have read and understand the above statement. *
Type full name here.

Code of Conduct

For the health, safety, and comfort of all clients, visitors, staff and volunteers, we ask that clients and visitors follow the guidelines/expectations in our Code of Conduct.

By clicking the submit button, I, the client is agreeing to the following terms:

- Be polite to all persons including Join Hands Staff and volunteers
- Respect all people, their property and Join Hands Ministry property
- Supervise children always
- Keep quiet on cell phones and electronic devices so that other clients, visitors, Join Hands Staff and volunteers can attend and focus on their work.
- Respect client privacy, when another client is with Join Hands Ministry staff or volunteer

The following are prohibited:

- Possession or use of any weapon
- Possession or use of street drugs or alcoholic beverages.
- Swearing, violence, or other disruption.
- Wearing clothing that has offensive words or pictures.
- Interfering with the care of a client.
- Using any form of tobacco inside and outside of all Join Hands Ministry properties. This includes e-cigarettes or vaping.

Clients and visitors who do not follow this Code of Conduct will be asked to leave Join Hands Ministry property. If serious circumstance, the police may be called. You may also be barred from Join Hands Ministry property indefinitely.
By typing your full name in the box below, you are providing your signature and acknowledging that you have read and understand the above statement. *
Type full name here.
Should be Empty:

NOTE:

Salvation Army - Financial Assistance Application