Desert Grace Church
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Do you attend Desert Grace Church?
Yes
No
If you do not attend Desert Grace, where do you attend church?
Have you received assistance from Desert Grace Church in the past?
Yes
No
Please list individuals living in your home, their age, and their relationship to you.
Employment Information
Current or most recent employer
Job position
Monthly income
If unemployed, are you currently seeking employment?
Yes
No
If unemployed, how long have you been unemployed?
Request Information
Amount requested
Date needed by
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
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2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
Type of assistance needed
Utility assistance
Food assistance
Transportation/fuel assistance
Other
Please provide a brief explanation of your situation and request.
How were you referred to us?
By checking this box, I verify that the above information is accurate and I give Desert Grace Church permission to follow up on the information provided.
I agree
You will be contacted via email once a decision has been made regarding your request.
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