Healing Forward Support Request Form 

Thank you for reaching out to Healing Forward Foundation.

Healing Forward provides limited short-term support, practical assistance, mentorship, and resource connection for eligible individuals and families experiencing temporary hardship.

Please complete this form as thoroughly as possible. Submission of this request does not guarantee assistance, as support depends on eligibility review, documentation, available funding, and organizational capacity.

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Full Name  *
Phone Number  *
Email Address  *
Preferred Contact *
Home Address  *
City/County  *
Household Sze  *
Are There Children in the Household? *
Are There Older Adults 50+ in the Household? *
What Type of Support are you Seeking?  *
Required
Please Briefly Describe Your Current Situation 
Is This need Urgent?  *
Have You Already Contacted Any Other Community Resources? *
Please Tell Us Which Resources You Have Contacted  *
Are You Able To Provide Supporting Documentation If Requested? 
  Documentation may include:
photo ID
proof of address
proof of income
lease / utility notice
other supporting documents  
 *
  Are You Interested In Optional Mentorship / Encouragement Support?   *
  Additional Information You’d Like To Share  
  AGREEMENT   *
Required
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