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Meeting the Community Needs - Crisis Request
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.
How did you hear about Meeting the Community Needs by Lending Helping Hands Crisis Initiative? *
WHO DO WE SERVE:
Individuals or families are who CURRENTLY experiencing an EMERGENCY CRISIS in PETERSBURG only.
WHAT SERVICES ARE YOU REQUESTING: 
*Petersburg only.
 *
Required
Have you received assistance from Lending Helping Hands before? *
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First Name   *
Last Name *
Cell Phone Number (Include Area Code) *
Total # of Persons Assisting? (A) *
Benefits to Low- and Moderate- Income Persons *
Required
Race/Ethnicity
Clear selection
Do your child(ren) attend Petersburg City Public School? *
Required
Are you familiar with McKenney-Vento Homeless Assistance Act of 1987? *
Required
Describe your crisis situation hardship. Be specific as to what has caused you to reach out to Lending Helping Hands. *
What is your current housing situation" *
Required
Clothing Description and Sizes: 
Person #1
WE ONLY KNOW WHAT YOU TELL US:  
For each person, please list sizes for the items you need. 
Name, Age, Gender and Style.
Height, weight - helpful for sizing
Top Size
Pant Size
Shoe Size
Sock Size
Bra Size
Underwear Size
Jacket/Coat Size
Clothing Description and Sizes:
Person #2
WE ONLY KNOW WHAT YOU TELL US: 
 For each person, please list sizes for the items you need. 
Name, Age, Gender.
Height, weight - helpful for sizing
Top Size
Pant Size
Shoe Size
Sock Size
Bra Size
Underwear Size
Jacket/Coat Size
Clothing Description and Sizes:  
Person #3
WE ONLY KNOW WHAT YOU TELL US:  
For each person, please list sizes for the items you need. 
Name, Age, Gender
Height, weight - helpful for sizing
Top Size
Pant Size
Shoe Size
Sock Size
Bra Size
Underwear Size
Jacket/Coat Size
Clothing Description and Sizes:  
Person #4
WE ONLY KNOW WHAT YOU TELL US:  
For each person, please list sizes for the items you need. 
Name, Age, Gender
Height, weight - helpful for sizing
Top Size
Pant Size
Shoe Size
Sock Size
Bra Size
Underwear Size
Jacket/Coat Size
If you are in need of FOOD please let us know if anyone has food allergies.  *
If you are in need for FOOD, please select what category of food is NEEDED? *
Required
Do you or your family member(s) need PERSONAL Hygiene Items? *
Required
Are feminine hygiene needed? If you do not need this, please skip this question.
Clear selection
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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