Due to the heavy volume of requests, we are only able to help assist with needs in the following locations at this time:New AlbanyPataskalaEtnaJohnstownBlacklickGahannaReynoldsburgWhitehallWesterville
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Name*
Name
(Only fill this out if more than one person is requesting assistance.)
, AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Phone( ) -
Email
How many people are living in your home?
How many are adults?
Please list the names of all adults living in the home.*
How many are children?
Do you have a church home? (If yes, please include the name of the church.)
Landlord Name and Contact
If applicable, please include the name and phone number of our landlord.
Yes
No
If yes, where are you employed?
If yes, how long have you been employed there?
Who referred you to Jersey Church?
If yes, were they able to help?
What other agencies have you contacted to help? How much can they help?
Please state the specific need/reason for applying for assistance.
Amount you are requesting:*
PLEASE NOTE
Current identification and a copy of a utility bill are REQUIRED.
Please be aware that we have a responsibility to our own congregational needs first. Provided that funds are available and criteria met, consideration will be made to assist non-members once in a 12 month period.
An appointment will be set up and someone will get back to you at that time.
