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Baby Request - Meeting the Community Needs
This form is used to capture the Federal REQUIRED information in order to provide assistance under the Meeting the Community Needs by Lending Helping Hands Initiative in PETERSBURG, VA only.

Community Development Block Grant (CDBG) FEDERAL Data Required.
Timeframe:  7/1/2024 - 6/30/2025
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This form is to be completed ONLY if you are experiencing an EMERGENCY CRISIS in the City of Petersburg.
Lending Helping Hands is more than our name, lending helping hands is what we do.
WHO DO WE SERVE:
Individuals or families are who CURRENTLY experiencing an EMERGENCY CRISIS in PETERSBURG only.
How did you hear about Baby Request - Meeting the Community Needs? *
Have you received assistance from Lending Helping Hands before? *
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First Name   *
Last Name *
Cell Phone Number (Include Area Code) *
WHAT SERVICES ARE YOU REQUESTING: 
 *Petersburg only.
 *
Required
Describe your crisis situation that has caused you to reach out to Lending Helping Hands. *
Total # of Persons Assisting? (A) *
Benefits to Low- and Moderate- Income Persons *
Required
Race/Ethnicity *
Clothing Description and Sizes: 
Infant #1
WE ONLY KNOW WHAT YOU TELL US:  
For each infant, please list sizes for the items needed. 
Name, Age, Gender.
Infant Weight - helpful for sizing
Top Size
Pant Size
Shoe Size
Sock Size
Jacket/Coat Size
What PERSONAL Hygiene item is needed? *
Required
Do you need diapers? Please choose the size below.
Clear selection
Select the one (1) SPECIFIC Formula Requested *
Date Requesting Assistant? *
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