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Hosea HelpsHosea Helps
  • Donations
    • Donate Now
    • Ways to Give
    • Host a Giving Drive
    • Financial Gifts
    • Giving Products
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    • Sponsor a Program
  • Programs
    • Our Mission
    • On Hosea Williams
    • Homeless Prevention
    • Care Center
    • Hosea on the Move
    • Services for Children
    • Holiday Dinner Events
    • Self-Sufficiency Programs
      • Women’s Life Skills Program
      • Labor of Love
    • Nonprofit Capacity Building
    • International Relief Efforts
    • U.S. Disaster Relief
  • Volunteers
  • Request Services
    • Register Your School
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    • Register Your Community
    • Hours of Operation
  • Upcoming Events
  • Contact Us
    • Share Your Story
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    • Using the Brand
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"Mommy and Me" Event Check-In

Human Services: Clients Mommy and Me 2025

Raffle Control Panel

Primary Agency Providing Services

The Date

Basic Information

Program Information

Select Relevant Programs

Services Requested

Select any services this household needs.

Summary of Services Provided

Mark any services that were provided.

Additional Information

Individual Service Plan

Demographics

Low-Income Household *
Age 55 Years or Older? *
Ethnicity? *
Gender? *
US Citizen or Legal Immigrant? *
Student? *
Military Veteran? *
Employed? *
Ever Been Homeless? *
Survivor of Domestic Violence? *
Free or Reduced School Lunch? *
Receiving WIC Benefits? *
Receiving TANF? *
Receiving Food Stamps? *
Receiving Section 8 Benefits? *
Use Public Transportation Weekly? *
Have a Disabling Condition? *

Household Snapshot

Add a Child

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Testimony

Maximum file size: 516MB

File Types: JPG, JPEG, PNG
Single line text only. No paragraphs.

Request SNAP Benefits

Apply for Benefits? *

Total People In Your Group

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