Mission Devine “Loving your neighbor as yourself” Matthew 22:39

2022 ASSISTANCE REQUEST FORM

*One project address per form – PLEASE RETURN BY May 14, 2022 to your Pastor or mail this application to:  PO Box 42, Devine, TX 78016.

Date of Application: ________________________                

Tell us about yourself: (Please print)

Name: ____________________________________                Age of Owner: ___________________

Address: __________________________________                City: ___________________________

School District: _____________________________                 Phone: _________________________

Alternate Contact: __ _________________________                   Phone: _________________________

Are you or someone living in the home a veteran?                        Yes____    No____
Are you a widow or widower?                                                        Yes____   No____
Are you or anyone living in this home disabled?                            Yes____   No____

Tell us about your home:

                   Do you own your home?                                                       Yes ___ No ____

                  Are you Currently Living in this home?                                         Yes ___ No ____

Do you own more than one home?                                  Yes ___ No_____
Is this a Mobile Home?                                          Yes ___ No_____

Do you have property insurance?                                    Yes ___ No_____

     Do you pay rent to live here?                                                  Yes ___ No ____

     Will you be living in this home after repairs are made?                 Yes ___ No ____

     Are you planning to sell this home after repairs are completed?    Yes ___ No ____

If you are not the owner, list the property owner’s name: ______________________________________

How many people are living in the home?                 ______      

How many years have lived in your home?                ______

Describe the work that needs to be done:

____________________________________________________________________________________

Is this your first request with Mission Devine for work to be done at this address?       Yes ___ No _____

If Mission Devine has worked on your home before, what was done and when?

____________________________________________________________________________________

Mission Devine “Loving your neighbor as yourself” Matthew 22:39

2022 ASSISTANCE REQUEST FORM (page 2 of 2)

Have you spoken to a Mission Devine Committee Member already?                 Yes ___ No ___

If so, please list their name: _______________________________

Tell us about your need:

Briefly describe why you need Mission Devine to complete this work for you: (Use back of page if needed)

Are there any members of the household or family that could help with this project?     Yes ___ No ____

If so please list their names, ages, contact phone number and time they may be available to help.

Name                                     Age                          Phone #                                      Available time to help

__________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________

I, _________________________________________________, hereby attest that all the information provided above is true and factual.

Signature______________________________                              Date Signed: _________________________

Would you agree to allow Mission Devine to take pictures of your home before and after Mission Devine work is done?   Yes_____   No _____   Initial_________               (your name and address will not be published)

Thank you for completing this form. We will make every effort to contact you.  Please make and keep a copy of this application. If you have not heard back from someone by MAY 29st 2022,

Email help@missiondevine.org to check on the status of your application.”

Mission Devine was organized by the Devine Ministerial Fellowship and is an ecumenical Christian organization

that strives to show God’s love by providing home improvements in a loving and compassionate way for those less

fortunate in our community. We do not discriminate on the basis of race, color, religion, sex, handicap, familial

status or national origin. Projects can only be approved as funding and volunteer crews are available – applications

will be considered based on the applicant’s need and our available resources. Any and all work will be performed

during our annual work week in June.