TESTING ONLY PAGE - Santa's Helpers


        

                

            

                        
            
                Santa's Helpers Christmas Assistance Application
                
This application is only partial information that our team needs to know to start the process of helping a family.  This information is only considered a request and after you submit the form, one of our team will contact you and get the further information that we need to finish the processing processing.  Please note that all the information you provide below will be verified.
            

        
                
                    
            If submitting your family, does your family have children under the age of 18 in the household? *
        
        
            
            
                
                            

        
                
                    
            Do you currently have a child with special needs that is living in your household or the household of the family you are applying for? *
        
        
            
            
                
                            

        
                
                    
            Please describe the special need so we can better accomidate the child. *
        
                                    
            
                                    
                    

                
                        
                                
                    
            Have you or the family you are referring ever been denied assistance by Santa's Helpers in the past? *
        
        
            
            
                
                            

        
                
                    
            Please describe the situation *
        
                                    
            
                                    
                    

                
                        
                                
                    
            If you are applying for your family this year, are you currently getting support from Love Inc.? *
        
        
            
            
                
                            

        
                
                    
            If you are applying for ANOTEHR FAMILY this year, are they currently getting support from Love Inc.? *
        
        
            
            
                
                            

        
                
                    
            Your Full Name *
        
        
            
                

                
                            
                    
                
                    
            Valid Email Address
        
        
            
                
                            
        
                
                    
            Current Valid Phone Number *
        
        
            
                

                
                        A current valid phone number is required here.  We will not be able to process your application if this number is not valid.
                    
                    
                
                    
            Are you applying for yourself or another family
        
        
            
            
                
                            

        
                
                    
            What is the name of the family you are applying for? *
        
        
            
                

                
                            
                    
                                
                    
            Phone number of the family you are applying for *
        
        
            
                

                
                            
                    
                                
                    
            Address that the assistance needs to go to.
        
        
            
                
                    
                                                    
                                                                    
                                                                

                            
                                Address Line 1                                *
                            
                                            

                
                    
                                                    
                                                                    
                                                                

                            
                                Address Line 2                                
                            
                                            

                
                    
                                                    
                                                                    
                                                                

                            
                                City                                *
                            
                                            

                
                    
                                            

                
                    
                                            

                
                    
                                            

                
                        List the address of the person that you are requesting assistance for.  If it is your family, just put your address in this field.
        
            

        
                
                    
            Please explain the reason for your application. *
        
                                    
            
                                    
                    

                
                        
                
            
                Please Read Before Submitting Request
                Please remember that this is only the partial information that is required to start the assistance process and is in no way guarantee of assistance.  Someone from our team will contact you and continue the application process.  Please also keep in mind that if we are unable to contact you within a reasonable time, your application may be rejected/refused.  Any fraudulent attempt to get assistance will result in rejection of your application and rejection of any further assistance.
            

        
                
                    
            SPAM CHALLENGE QUESITON = Please Choose the Proper Area Code for Alaska *
        
        
            
            
                
                        This is an anti-spam challenge question.  This reduces the about of fake/spam entries that we receive.  Less spam equals faster response times to your real requests.