Referral Form Flagler County - Abundant Life Ministries-Hope House, Inc.

First Name *

Last Name *

Email Address *

Phone Number *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Select Marital Status

Household Size

Provide Florida identification, birth certificate(s) for all minor(s), social security cards for household member(s) along with proof of income or receipt of benefits (SNAP/Food Stamps, SSI, Medicaid, or TANF) and proof of need, such as a past due utility bill, prescription invoice, eviction or past due notice (rental assistance application signed by landlord will suffice as past due notice). Clients will also be asked to complete a Monthly Budget Worksheet. *

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© 2024 Abundant Life Ministries-Hope House, Inc. Abundant Life Ministries – Hope House, Inc. is a 501(c)(3) nonprofit recognized by the IRS, and all donations to ALMHHI are tax deductible in accordance with IRS regulations. ALMHHI follows a policy of non-discrimination in accordance with the law.