Benevolence - Request for Assistance
Request For Assistance Guidelines
The goal of the PH4U Hope Chest is to pour hope back into our community by meeting practical financial needs to those seeking assistance. While our desire is to help everyone, we are limited to helping those that are PH4U clients, currently receiving other services.
• It takes at least 2 weeks to process any financial request.
• No cash will be given out anytime for any reason.
• PH4U will make payment directly to the company to which the payment is owned.
• If approved, additional documentation will be required.
Personal Information History
Please provide the following information on all persons, other than yourself, living in your home with you: Name; Date of Birth; Are they working and/or contributing any money to the household expenses?
Person 1 - Full Name
Person 2 - Full Name
Person 3 - Full Name
(EX: My needs in priority list - 1. Rent 2. Utilities) *
Documentation required before consideration.
*A copy of the full bill that you are requesting assistance with and/or other documentation
*A copy of your photo ID
*If you are needing assistance with rent or mortgage; please upload a copy of your complete lease agreement or mortgage statement.
*I understand I will have to provide correct and full documentation before I can be considered for assistance from Pregnancy Help 4 U. *
*I hereby authorize the release of information to Pregnancy Help 4 U (PH4U) to receive the assistance I am requesting. I further certify the information I have stated is true and correct and that all income is reported. I understand PH4U may verify the information on this application and that deliberate misrepresentation of information may subject me to denial of assistance/services.
*I give permission for PH4U to discuss my case with other agencies, businesses, churches, attorneys, individuals, and any other deemed necessary to verify application information and/or identify additional sources of assistance. I understand that all information will remain as private as possible within these entities.
*I understand that the assistance I am applying for may not be approved.
*I have read, understood, and agree to the policies above regarding the Release Of Information.