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.Open Enrollment Notice!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 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict 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)List Childs Shoe SizeFirst Childs Shoe Size TypeInfantToddlerLittle KidBig KidAdultFirst 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 KidAdultSecond Childs Sex (copy)MaleFemaleSecond Childs Shoe Size (copy)11.522.533.544.555.566.577.588.599.51010.51111.51212.5Childrens Birth CertificatesUpload 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 Monthy IncomeUpload your paystub, or other proof of income fo 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 AgreementCopy of rental/lease agreement * 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 information may be requestedSubmit
