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We are here to help. Please complete this form as thoroughly as possible so we can best serve your family's needs. All information provided is kept confidential.
Please upload any relevant supporting documents to help us process your request. Examples include:
Rent or Lease Agreement
Past Due Utility Notices
Eviction or Disconnection Notices
Proof of Income or Unemployment
Any other relevant documentation
Please upload images or documents only (e.g., PDF, Word, JPG, PNG). Up to 10 files may be uploaded.
By submitting this application, I acknowledge and agree to the following:
The information provided in this application is true, accurate, and complete to the best of my knowledge.
I understand that providing false or misleading information may result in disqualification from receiving assistance.
I understand that hardship assistance is subject to availability of funds and is not guaranteed.
I consent to St. John's Place of Grace using the information provided solely for the purpose of evaluating and processing this assistance request.
I understand that all information submitted will be kept confidential and used only by authorized staff.
I have read and agree to the acknowledgment statement above. I certify that all information provided is truthful and accurate.*