Balanced Budget Program Interest Form

After completing the following form you should hear back within 2 business days with either another e-mail for you to fill out a budget form or a call. Please make sure to check your SPAM! If you do not hear back within this time please call 765-644-2121.

Please be prepared to have the following items as we move forward in the budgeting assistance process:

Picture ID for ALL adults in the household
Proof for ALL children in the household (birth cert., health card, school record, etc.)
Proof of income for the household for the last 30 days
Receipts for one-time expenses in the last 30 days
Copies of ALL bills that you pay monthly
A copy of your lease
Sign in to Google to save your progress. Learn more
Email *
Operation Love Ministries' Budget Assistance Program is based on long-term success and sustainability. Are you interested in completing short-term and long-term financial goals? *
What is going on that led you to reach out for assistance (i.e. loss/reduction in employment, moving into new residence, unexpected expense, loss/reduction in benefits, issues with debt, etc.) *
Basic Information
Please fill out the following required information:
Name *
Date of birth *
Phone Number *
Financial Information
Next, we will need some basic information about your income:
Do you or someone in the household have a current source of income? (check all that apply) *
Are you on any assistance programs? (Check all that apply) *
Have you received assistance from any organizations? (Check all that apply) *
When is expense due? *
Were you referred by any other organization? If yes, who referred you? *
Preferred method of contact
Clear selection
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Operation Love Ministries, Inc.. Report Abuse