Financial Inquiries

Your name *

Email address *

Phone Number

Applying for: *

*This program does NOT assist with rent, vehicle repairs, or prescriptions*

Electric

Water

Food

Other

Birthday *

Social Security Number *

License Number

Address *

How long have you lived at this current address?

Rent or Own

Amount of rent/mortgage:

Do you have dependents? *

Personal Reference

Phone Number *

Personal Reference Name: *

Address

Employer Name:

Phone Number *

Address

Total Monthly Income:

Are you unemployed? *

Do you receive assistance? *

Are you currently attending church? *

How did you hear about us?

If we are unable to assist you, what other options do you have?

Have you received assistance from Highest Praise or any other source this year? *

Describe in detail the approximate numeric amount of your need and how you feel we can help: *

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.