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Evangeline Helps

Direct Assistance Program

Important Information

Evangeline Helps is a dedicated program committed to providing support and assistance to those in need. By submitting this application, you are formally requesting assistance. The information you provide will be exclusively used for evaluating your application and determining eligibility.

Your application will be reviewed by the Evangeline Helps Program Manager and may be subject to review by the Evangeline Board of Directors. This multi-tiered review ensures all requests are handled with thoroughness and integrity.

Once reviewed, you will receive a summary determination via email, and a detailed letter will be mailed to your home address. Please ensure all information provided is accurate and complete.

Evangeline Helps Application

Apply for direct assistance and emergency support.

Personal Information

Full Name *

Email *

Phone Number *

Is the phone number you provided: *

Date of Birth

Gender Identity

Pronouns

Sexual Orientation *

For demographic tracking only. This information will not be used in approval or eligibility decisions.

Race / Ethnicity

Address

Household Information

Household Size

Annual Household Income

Household Members *

Current Housing Status *

Lease Agreement

Employment & Income

Employment Status *

Your Total Monthly Income *

Including employment, Social Security, retirement, stocks, bonds, child support, and any other sources.

Total Monthly Household Income *

Combined monthly income of all working adults or individuals who bring in income in your home.

Monthly Expenses *

Payment Status *

Assistance Request

Type of Assistance Needed *

Amount of Assistance Needed *

Reason for Assistance *

Anything else you'd like to share?

Eligibility

Eligibility — Select all that apply *

Low IncomeSNAP RecipientMedicaid RecipientSection 8/Housing AssistanceWIC ParticipantTANF RecipientSocial Security/Dis BenefitsVeteranNone of the above

Do you have proof of the qualifying program you selected above? *

Do you shop at Kroger or any of its Family of stores? *

If you shop at a Kroger banner store, you will be enrolled in the Kroger Community Rewards program, which benefits Evangeline Inc. through Kroger donations at no cost to you.

Consent & Acknowledgments

Last 4 Digits of Social Security Number *

Only the last 4 digits are required here. A copy of your Social Security card will be needed during the verification process.

Funding & Payment Acknowledgment — Yes, I agree to this full statement *

Fraud Warning Acknowledgment — I AGREE to the complete and full statement *

Marketing & Promotional Materials *

This is required to answer, but the choice is yours — opt in or opt out.

Yes, opt me in to marketing and promotional materialsNo, I do not want to receive marketing and promotional materials

I certify that the information provided is true and accurate. I understand that Evangeline will review my application and contact me regarding my request. I consent to Evangeline storing and processing my personal information for the purpose of this application.

Supporting Documents

⚠️ In order to submit your application, all selected documents must be attached. Government-issued Driver License or ID is required by default. Please select all documents you are including and upload the matching files.

Selected: 1Files uploaded: 0

Government-issued Driver License or IDRequired

Required by default

Click to upload or drag and drop

Multiple files allowed (PDF, DOC, images)

Copy of Utility Bills (full bill required, front and back)

Copy of Lease Agreement

Proof of eligibility (for qualifying program selected above)

Other (specify below)