Application Form for Programs/Services/Aid
To be eligible for The Amish Heritage Foundation's programs/services, you and/or your parents must have been raised Amish. That said, exceptions may be made because we're gathering data to refine our eligibility terms; if you identify as Amish or of Amish heritage, please apply. YOUR INFORMATION IS KEPT CONFIDENTIAL. If you have any questions, please email or give us a call if your situation is urgent.
Email address *
First Name *
Last Name *
Mailing Address *
Email *
Date of Birth *
Website (if you have one)
Social Media links (Facebook, Twitter, Instagram, etc. if you have one)
Father’s Name: *
Mother's Name: *
Name of Guardian if Not Living Parent: *
Write "n/a" if you're age 18+.
Are/were one or both of your parents born and raised in the Amish Church? *
Are one or both of your parents still inside the Amish Church? *
Did you personally escape from the Amish Church? *
Which Church were you born/raised in? *
Select "N/A" if this question doesn't apply to you.
Do you speak English as a second language? *
How old were you when you escaped/left/resigned? *
Write "n/a" if this question doesn't apply to you.
When (what year) did you escape/leave/resign? *
Write "n/a" if this question doesn't apply to you.
Which State did you escape/leave/resign from? *
Write "n/a" if this question doesn't apply to you.
I'd like the following assistance: *
Select all that apply and if you need help with something not listed here, explain what you need in your essay.
Write a short essay (500 words minimum and 1500 words maximum) in .doc, .docx, or .pages format (Word Doc or Mac Pages), describing your situation and what kind of programs/services/aid you'd like. E.g., If you'd like legal help, describe what kind of legal help you need. Include one paragraph (3 sentences) about your Amish origins or escape story. *
Upload your essay via this upload link.
Submit your resume (if you have one) *
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