Junior Auxiliary of Hattiesburg Financial Assistance Request
JAH is committed to meeting the needs of women, children and under-served populations in the Hattiesburg community. While we work to meet every request possible, we do have to follow guidelines so that our funds are allocated appropriately. This assistance is not limited to individuals. Non-profit organizations, schools, etc that provide services to women and children and other under-served populations in the Pinebelt are also able to apply. -Utility Assistance will not be considered until after the 15th of each month. Maximum utility assistance of $150 if funds allow: minimum to keep service on. We will not pay deposits. -We do not provide assistance with car notes or loans. -Submissions are evaluated by a committee on a case by case basis in which multiple factors are considered. -You will be contacted within 3-4 business days regarding the status of your request. -Individuals will only be considered for assistance ones per calendar year.
Name of individual submitting request:
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First Name
Last Name
Phone number for individual submitting request:
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Please enter a valid phone number.
Email for individual/organization requesting assistance:
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If you are submitting for someone else
I am submitting this request on behalf of myself:
Yes
No
If no, please list the name of the individual or organization you are submitting on behalf of:
I am submitting as an:
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Individual
Non-profit organization
School
Address of Individual or Organization Requesting Assistance:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you are an individual requesting assistance, are you employed?
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Yes- Full time
Yes- Part time
No- unemployed
No- Disabled
Please tell us what type of assistance is needed: (utilities, food/nutrition, child related, clothing/footwear, etc). Please give us the amount being requested and what that amount is for. (For example, if you need utilities, tell us the amount you need and how long a time period that amount is for.)
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Amount of Assistance Requested:
If you are requesting rent assistance, who is your landlord/property manager?
What is their phone number?
Please enter a valid phone number.
If you are requesting utility assistance, list your utility provider AND account number.
Please give us some background information on the situation that caused the need for assistance. Please provide as much information as possible so we can best understand the need being requested.
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Please provide a character reference that is outside of your family. References will contacted to verify the severity of the need.
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Phone Number for Character Reference
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Please enter a valid phone number.
Submit
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