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NEW JERUSALEM OUTREACH MINISTRIES
CHRISTIANS ASSISTANCE REVIVING EDUCATION SUPPORT CENTER (CARES)
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CARES APPLICATION FORM
First Last MI
Date
Email
Adress
Phone
DOB
Application Questioner Check All That Applies
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Are you a citzen of the united states?
Are you here for Marraige or prematial counseling?
Do you Need help with parenting?
Do you need help with Social Securty
Do you need help with GED,FASFA, or college applications?
Do you need assistance with housing?
Do you need prayer?
Do you need clothing?
Do you need help with food?
Do you need assistance with refferral services or mental illness?
Do you need help with transportation?
Do you need help with SNAP or Medicaid
Do you need assistance with mentorship for yourself or your child?
Do you need assistance with career planning or resume writing?
Do you need assistance with finacial budgeting?
Do you need assistance with life coaching?
None of the above/other
Any futher comments queston or concerns please text here.
Submit
Thanks for submitting!
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