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Please read the following when completing a Request Form for assistance.

Understanding and following these instructions, helps us to assist you better. 

If you know of someone that could use our help, and they do not live in your household, please direct them to complete the application separately

Request Form

It is your responsibility to completely fill the form out  accurately. Please make sure each need is described for each of your children. Please give specific details of sex , age , sizes along with their needs. Please fill out each box, if it does not apply to your situation please mark the box N/A. If you do not fill the form out completely and accurately, we may not be able to assist your family with the needs you are requesting. 

Contacting Family

After completing the Request Form, please be available for contact. A member of PURE will reach out by one or all of the ways you have given as your contact information, within 7 business days of application submittal. It is your responsibility to check text messages, voicemails, email, etc. If your contact information changes, it is your responsibility to notify PURE ASAP. 

Response Time

You must respond within (2) days after contact from PURE to continue your application process. If you fail to do so, PURE will no longer be able to move forward with your application and you will need to reapply

Request Form for Help

Please note: All children ages 0-18 must live in the household of family requesting help.  Young Adults with Specials Needs can be requested for up to the age of 21

Help request Form
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Thank you!

Passion Unity Respect Equality 

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