Love In The Name of Christ
Love I N C Logo
sample pics

Application for Holiday Assistance

Note: Acceptance of applications for Holiday Assistance closes as of Midnight, Friday, 11/17/17

Profile Information

This form must be completed in full and submitted by parent or legal guardian


* Name required

Birthdate of parent / legal guardian:


* Name required

Birthdate of spouse / or other adult in home:

______


* phone number requiredInvalid format. (***) ***-****


* phone number requiredInvalid format. (***) ***-****


* email requiredInvalid format.


* physical mailing address required


* city required


* state required


* zip code requiredInvalid format.



Monthly Household Income: (all finances must be listed):


* dollar amount required


* dollar amount required


* dollar amount required


* dollar amount required


* dollar amount required


* dollar amount required


* dollar amount required






* source required. Enter NA for Not Applicable.

______



______

Birthdate for first child:


* first and last name required



______

Birthdate for second child:




______

Birthdate for third child:




______

Birthdate for fourth child:




______

Birthdate for fifth child:




______

purple decorative heart

Love INC

Love Notes

“Therefore if you have any encouragement from being united with Christ, if any comfort from his love, if any common sharing in the Spirit, if any tenderness and compassion, then make my joy complete by being like-minded, having the same love, being one in spirit and of one mind. Do nothing out of selfish ambition or vain conceit. Rather, in humility value others above yourselves, not looking to your own interests but each of you to the interests of the others” — Philippians 2:1-4