United Christian Ministries: Financial Assistance Request Form
If you are seeking ONLY food assistance, you do NOT need to fill out this form. We have implemented a drive-thru system, so you don't have to get out of your vehicle. We are open on Mondays, Wednesdays and Fridays from 9-noon. Please bring your ID.
Email address *
A UCM representative will be contacting you as soon as possible to conduct an intake interview over the phone. Our normal procedures would require you to come in for a face-to-face intake but, due to COVID-19, we are modifying our procedures.
What is your FIRST name as it appears on your ID? *
Your answer
What is your LAST name as it appears on your ID? *
Your answer
Please provide a phone number where you can be reached during the day. *
Your answer
Have you received food or financial assistance from United Christian Ministries before? *
Required
How can we help you? What kind of financial assistance are you requesting help with today? *
Required
We often need to contact other agencies in order to determine the approval or denial of your request for financial assistance. This may include your utility company, landlord, employer or other local agencies that you have recently received financial assistance from. (Check only one box.) *
Required
As stated above, a UCM representative will be contacting you as soon as possible. Below are the topics that will be discussed during the intake process. Please check each box after you have read the descriptions so that you will be prepared to answer related questions during the intake. *
Required
Before any financial commitments can be made, we will need the following documents from you. You can either email a copy or picture of them to ucmpc2018@gmail.com or fax them to 864-671-1135. During the intake process, we can discuss further and answer any questions you have. Please check all the boxes below after you have read each requirement. *
Required
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