“Helping Hands Grant Application,”

  Helping Hands Fund Application   Name _____________________________________________________________                                                                                                                                                                                     Last                                    First                                Middle   Address ____________________________________________________________                        Box Number                        Street                  ____________________________________________________________                   City                                     State                                 Zip Code   Phone (_______)___________-__________________Home(__)  Mobil(__) Email______________________________________________________________ Most recent adjusted gross income (from your W-2) $______________________ Employed (___)    Unemployed (___) Number of people living in the home. _______ Brief description of medical condition or conditions and any special circumstances that we need to know about.  (Please limit to three to five sentences) We will ask for additional info if needed. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Mail/Email: Acts Ministry, Inc. 1736 E. Sunshine Suite 216 Springfield, Mo. 65804 4321acts@gmail.com _______________________________________________________________________________________________ Signature/Date:_______________________________________________________________________________

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