Application for Assistance At Angel Helpers Ministry we are thrilled to help families in need. In order to ensure that our efforts are well founded we ask you please fill out the application below if you desire help for your family. 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.Open Enrollment is from 10/1 - 11/1. Applications submitted outside these dates will not be processed!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 & Shoe Size)List Childs Shoe SizeFirst Childs Shoe Size TypeInfant 1-4Toddler 4.5-10Little Kid 10.5-3Big Kid 3.5- 7 (youth)Adult (6-16 Men) (4-12 Women)First Childs SexMaleFemaleFirst Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add A Second Childs Shoe SizeAdd A Second ChildSecond Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultSecond Childs SexMaleFemaleSecond Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add A Third Childs Shoe SizeAdd A Third ChildThird Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultThird Childs SexMaleFemaleThird Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add A Fourth Childs Shoe SizeAdd A Forth ChildFourth Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultFourth Childs SexMaleFemaleFourth Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add A Fifth Childs Shoe SizeAdd A Fifth ChildFifth Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultFifth Childs SexMaleFemaleFifth Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add A Sixth Childs Shoe SizeAdd A Sixth ChildSixth Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultSixth Childs SexMaleFemaleSixth Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add A Seventh Childs Shoe SizeAdd A Seventh ChildSeventh Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultSeventh Childs SexMaleFemaleSeventh Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add An Eighth Childs Shoe SizeAdd An Eighth ChildEight Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultEight Childs SexMaleFemaleEight Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add A Ninth Childs Shoe SizeAdd A Ninth ChildNinth Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultNinth Childs SexMaleFemaleNinth Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Click The Checkbox Below To Add A Tenth Childs Shoe SizeAdd A Tenth ChildTenth Childs Shoe Size Type InfantToddlerLittle KidBig KidAdultTenth Childs Sex MaleFemaleTenth Childs Shoe Size11.522.533.544.555.566.577.588.599.51010.51111.51212.5Childrens 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 SignatureAngel Helpers Ministry is in Contact with other Agencies. By signing below, I understand that Angel Helpers Ministry will be checking to verify that I am NOT receiving help from any other Agencies for the Holidays. By signing below, I am also giving Angel Helpers Ministry permission to check my references as well as stating everything in this application is True and Correction to the best of my knowledge. If any information in this form is incorrect I am aware that AHM reserves the right to deny me any future help or assistance. I also understand this application does NOT guarantee that my family will receive assistance.Signature *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.Submit
