Application for Holiday Assistance Please enable JavaScript in your browser to complete this form.Important Notice! Open enrollment is October 1st- October 31st. Any applications received outside of that time, will not be processed. Please do not submit more than one application, as this will delay the processing of your application. Any fields left blank or proper documents not provided, will result in your application being discarded…Angel Helpers Ministry Verifies with other agencies for anyone that is signed up for assistance with other agencies. Double dippers will be banned.Applicant InformationMother's NameFirstLastFather's NameFirstLastTodays Date *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *List Everyone In The HouseholdList everyone in your household: *(Names, Male or Female & Age)Childrens Birth Certificates Or Placement paperwork if you are a Kinship homeUpload a scanned copy of your childrens birth certificates * Click or drag files to this area to upload. You can upload up to 10 files. Proof Of Monthly Income (Upload any Government assistance your household receives)Upload your paystub, or other proof of income for EVERY MEMBER of your household * Click or drag files to this area to upload. You can upload up to 7 files. Copy Of The Households Rental/Lease Agreement (Hand written notes will not be accepted)Copy of rental/lease agreement (Submit housing if you have it here) * Click or drag files to this area to upload. You can upload up to 2 files. Disclaimer and SignatureSignature *FirstLastBy entering my full name in the fields above I agree it is binding as my Legal Signature. *Additional Info may be requested Angel Helpers Ministry reserves the right to refuse service to anyone. BY SIGNING HERE, YOU ARE ACKNOWLEDGING THAT ANGEL HELPERS MINISTRY IS NOT RESPONSIBLE FOR ANY ACCIDENT.Email *Submit
