Unity Outreach Financial Aid Application

Unity Outreach Financial Aid Application

We strive to help everyone in need, if not financially at least with referrals to help meet the need. As we are a non-profit organization, our funds come from community donations and fund raising events. We work diligently to make those funds meet as many needs as possible. If you have questions or issues completing this application, please contact Sherry 904-955-5045 or Peggy 904-571-1658

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Country

Maximum file size: 516MB

2. Do you have an immediate need?
4. Do you have income?
5. Do you currently receive any assistance?
6. Have you applied for assistance elsewhere?
7. Do you have health insurance?
8. If you have insurance, does it cover prescriptions?