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Help Application
Angels Application Form
PLEASE NOTE: AS OF NOV. 30th all of our Dec Appointments are booked. We have switched everything over to our Christmas Outreach Program. Unfortunately, due to space we cannot run the programs at the same time. We will ONLY be doing EMERGENCY Appointments through Caseworkers / Agencies. You can fill out the form below and reach out to us in the new year for an appointment.
Yes I understand I may not get an appointment until the new year. It will be my responsiblity to txt 856-625-8652 after Jan. 10th, 2024.
First Name
Last Name
Your Email
Address
Address Line 1
City
State
Zip Code
Phone/Mobile
Your Birth Date (example 09/20/88)
We will help as many people as possible. PLEASE Check below that you understand that filling out this application DOES NOT guarantee help/services.
Yes, I understand that completing this form does not guarantee assistance
Angels Community Outreach is located in Pitman NJ 08071. Please only fill out this form if you are local to the area. LOCAL means you live near and can come to our location in person. You do not have to live in Pitman.
Yes, I am local to the area.
Are you a past or current client of Angels Community Outreach?
Yes
No
What help are you in need of?
Clothing
Food
Toiletries
Baby Fomula
Baby Food
Baby Diapers
Pet Food
Other - please explain in the comment section below.
Are you working at this time? This information will help us match assistance for you.
Yes, I am working Full-Time
Yes, I am working Part-Time
I am Not currently working
I am retired
I receive Disability
Other, please explain below
Please explain work situation here.
Are you receiving Unemployment?
Yes
No
Are you receiving SSD?
Yes
No
Are you receiving Food Stamps?
Yes
No
Do you receive State Health Insurance? (NJ FamilyCare)
Yes
No
Do you have any questions for us? Do you have any information you would like to share with us? Example: Out of work, death in family, living in motel etc. Do you have other needs or concerns at this time? (Example: in need of diapers, formula, clothing needs, food needs, past due bills etc.?) Please share this information here.
Spouse/Partner Name
Spouse/Partner's last day of work?
Number of Adults in your household
Number of Chldren in your household (You will be asked to bring birth certificates for each child)
Please list FULL NAME, BIRTHDATE and AGE for EACH CHILD IN YOUR HOUSEHOLD.
Total monthly family income at this time:
Monthly Rent/Mortgage
Are you or anyone in your household a Veteran?
Yes
No
Do you have a referral letter for services?
Yes
No
If yes, from whom is the referral letter?
If your application is approved, you will need to bring all documentation / paperwork requested above. Please call or txt us at 856-625-8652 if you have any questions.
Yes, I understand
After you have completed this application and click the submit button, please TXT 856-625-8652 for the next steps.
Yes, I understand I must txt 856-625-8652 with my FULL NAME and NEEDS at this time.
Cancellation Policy - PLEASE NOTE once you are given an appointment time, it is your responsibility to show up on time for your appointment or to txt/call us to let us know you cannot make it. NO SHOWS will be put on a 6 month waiting list.
Yes, I understand I must Txt or Call 856-625-8652 if I cannot make my appointment time or I will have to wait 6 months before making a new appointment.
Submit Form