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HELP LOVE FOUNDATION

Apply for Help Love services

Full Legal Name

Phone

Email Address

Physical Address (no PO boxes)

Alternate Phone

Emergency contact name, relationship, phone number, email

What services are you looking for?

How did you hear about us?

What is your employment status?

Full Time

Part Time

Unemployed

Student

What is your legal marital status?

Single, never married

Married

Divorced

How many people live with you and what is their relationship to you?

How many people work in your home?

What is your annual household income? (include ss, child support, etc.)

Are you currently or have you been on any government assistance? Pls specify.

Is anyone living with you on government assistance? Please provide name and type of assistance.

Have you or anyone in your home been convicted of a crime? If so, please list who and when and all details.

Are you or anyone living with you a veteran?

Yes

Are you or anyone living with you receiving veteran benefits?

Yes

Have you or anyone in your home been employed by Help Love Foundation or its affiliates? If so, when?

Have you received any prior assistance from Help Love Foundation? Please share dates and services provided.

If you’ve falsely answered and/or reported any information on this application your application will automatically be WITHDRAWN.

Thank you for applying. You will be contacted within 5 business days of the date of this application to advise you whether you've met the program qualifications and if funds are available. Every applicant will be contacted with a decision.

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FACEBOOK

INSTAGRAM

CONTACT >

T: 1 833-HLF-LOVE / 1-833-823-7873

E: hlf@helplovefoundation.org

Mailing Address:

P.O BOX 542405

SUNRISE, FL 33345

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