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St. Vincent De Paul Society Assistance

- St. Vincent De Paul Society

St. Mark St. Vincent de Paul provides assistance to those in need in Ama, Luling and Waggaman. We are grateful to the support of parishioners of St. Mark through the Poor Box at the back of the church.
St. Mark St. Vincent de Paul Client Application Form
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- Date REQUIRED Please fill out this field. Please enter valid data.
- Referred By Please enter valid data.
- Head of Household Name
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Please enter valid data.
- House Phone Please enter valid data.
- Work Phone Please enter valid data.
- Physical Address
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Home Status REQUIRED Rent Own Please fill out this field.
- If renting, add landlord's name and phone number Please enter valid data.
- Mailing Address (If different from physical address)
- P.O. Box Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Marital Status REQUIRED Single Married Divorced Widowed Please fill out this field.
- Persons in the Household
  
  1. Name Please enter valid data.
  
  Relationship
  
  Age Please enter valid data.
  
  Grade Please enter valid data.
  
  School Attending Please enter valid data.
  
  2. Name Please enter valid data.
  
  Relationship
  
  Age Please enter valid data.
  
  Grade Please enter valid data.
  
  School Attending Please enter valid data.
  
  3. Name Please enter valid data.
  
  Relationship
  
  Age Please enter valid data.
  
  Grade Please enter valid data.
  
  School Attending Please enter valid data.
  
  4. Name Please enter valid data.
  
  Relationship
  
  Age Please enter valid data.
  
  Grade Please enter valid data.
  
  School Attending Please enter valid data.
  
  5. Name Please enter valid data.
  
  Relationship
  
  Age Please enter valid data.
  
  Grade Please enter valid data.
  
  School Attending Please enter valid data.
  
  6. Name Please enter valid data.
  
  Relationship
  
  Age Please enter valid data.
  
  Grade Please enter valid data.
  
  School Attending Please enter valid data.
- What type of help is requested?
- What circumstances have caused you need for assistance?
- Have you ever received assistance from St. Mark St. Vincent de Paul? Yes No
- Date Assistance Received Please enter valid data.
- Are you employed? Yes No
- What training/skills do you have?
- Place of employment Please enter valid data.
- Monthly salary $ Please enter valid data.
- Other sources of income (monthly) - Check all that apply Child Support Disability Social Security Pension Food Stamps Welfare Family/Friends
- Monthly Bills
  
  Housing $ Please enter valid data.
  
  Utilities $ Please enter valid data.
  
  Car Note $ Please enter valid data.
  
  Insurance $ Please enter valid data.
  
  Food $ Please enter valid data.
  
  Medical $ Please enter valid data.
  
  Cable $ Please enter valid data.
  
  Other (explain below) $ Please enter valid data.
- List/Explain other expenses
- The mission of St. Mark St. Vincent de Paul is provide help to those in need. Our resources are limited; however, we will make every effort to meet your emergency needs. We understand that everyone needs help at difficult times in their lives. With that, our motto is to provide a Hand Up, Not a Hand Out. We may be working closely with Catholic Charities and other local organizations to request services to assist you. By signing this form, you are giving us permission, if necessary, to contact other agencies to find additional assistance for you.
- I Agree Please select this field.
- Applicant's Signature REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Email Please enter an email address.
Submit

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- Click here for St. Vincent De Paul Society Assistance Form
Louisiana 211 & 988 Lifeline

https://www.louisiana211.org/ or simply dial 211 and ask for the information you need, telling them what parish you live in. Information for foodbanks, counseling, or other assistance is available.

Suicide prevention hotline: dial 988 https://988lifeline.org/talk-to-someone-now/

St. MARk Parish

Ama, Louisiana

St. Vincent De Paul Society Assistance

St. Mark St. Vincent de Paul Client Application Form

Louisiana 211 & 988 Lifeline