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Apply for Assistance

If you are experiencing financial hardship and could benefit from temporary assistance and compassionate support, please complete the application form below.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Name*

First Last

Address*

Street Address City State Zip

Gender*

Male

Female

Age*

Phone*

Email*

Do you:*

Own

Rent

Other

Please specify*

Do you have children?*

Yes

Ages*

Do you have other family?*

What is your highest level of education?*

Are you employed?*

Yes

Other

Other:*

If employed, where do you work?*

Position or title*

Relationship Status*

Married

Single

Divorced

Domestic Partnership

Circumstances or reason for need?*

Specifically, what will the funds be used for?*

How long have you had their need?*

How urgent is your need?*

How long have you had their need?*

What is the duration of your need?*

To address your need, do you desire

Grant

Loan

Unsure

Do you know of any other resources you may have that could assist you with your need (family, friends, church, etc.)?*

Do you have a faith or believe in God?*

Yes

How important is your belief to you?*

What is your religion?*

Do you attend a worship service? If so, where?*

Additional relevant information about your need:

As a requirement for funding, are you open to hearing our faith witness?

Yes

Unsure

Do you consent to us furnishing information about you with specific donors who may be interested in helping fund your need?

Yes

Unsure

Confidentiality Statement

Amor Christi will not share any information provided by either the donor or recipient with any outside individuals or entities unless specifically authorized by the respective parties.

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admin@amorchristi.org
PO 794081 Dallas, TX 75379

What We Do
Who We Help
Our Mission
How To Help
Donate
Submit a Referral
Apply

Apply for Assistance

Quick Links

Contact Us

Donate

Submit a Referral

Apply