All Purpose Assistance Form
*Please review the most recent notes about assistance (what we have current funding for) before you fill-out this online form. It may take 3-5 business days to receive a reply. We are working through requests as quickly as possible. We apologize that the threat of the Coronavirus has made an online form a necessity, since we would rather meet with you in person to help you in your time of crisis.* With Love & Prayers, The Majors Thies
Email *
First Name *
Last Name *
Date Of Birth *
Please enter your legal date of birth
MM
/
DD
/
YYYY
Please enter the last four digits of your Social Security Number. (This is used for inter-agency reporting and verification of previous assistance)
What is your current need? *
Many clients have multiple needs, but please just select or enter the most urgent need and reason for your form submission.
Why are you in need of help today? *
Please provide details of WHY you are in need, not what you need.
Have you sought help with this need elsewhere? *
Please list the organization/institution/person where you have sought assistance, WHEN you sought assistance, and the result of your request.
(For example: I sought assistance for household items from Operation Threshold yesterday the 16th of March, but they didn't have what I needed.) If you answered NO above, then please skip this question.
Have you received the requested assistance from The Salvation Army before? *
If you answered YES to the above question, when and what type of assistance did you receive?
Phone Number With Area Code *
If the above phone is not your personal phone, what is the name of the intermediary contact?
What is your preferred method of follow-up contact? *
As of today, what are your three most significant other needs?
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