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Charity Assistance Form

Name:

First Name

Last Name

Contact information:

City

State

Zip code

Phone number

Background information:

Gender: M F

USA Resident: Yes No

Disable: Yes No

Race/Ethnic Background

Are you applying for assistance on behalf of an individual or an organization? (Please check one) Individual Organization

If you are applying on behalf of an organization, please provide the organization's name and a brief description of its mission: Organization Name
Organization Mission:
Please provide a brief explanation of why you or your organization is seeking charitable assistance:

Financial Information:

Employed? Yes No

Annual Household Income (for individuals) or Annual Revenue (for organizations):
Monthly Expenses (for individuals) or Monthly Expenses (for organizations):

Do you currently receive any government assistance? Yes No
If yes, please provide details:

Have you received charitable assistance in the past? Yes No
If yes, please provide details:

Requested Assistance:

Please describe the specific type of assistance you are seeking and how it would benefit you or your organization:
Please provide an estimated amount or value of the assistance requested:
Are there any specific timelines or deadlines associated with your request? (Please check one) Yes No
If yes, please provide details:

Declaration:

By sibmitting this form, I certify that the information provided in this form is true and accurate to the best of my knowledge. I understand that providing false information may result in the denial of assistance.

Date:

Your message has been sent. Thank you!

Thank you for completing Eight Dimensions Charity Assistance Form. We will review your application and contact you using the method of contact provided above. Please note that submission of this form does not guarantee assistance, as all requests are subject to evaluation and availability of resources.

Eight Dimensions Charity

Fort Worth,
Texas
United States

Email: eightdimensionscharity@gmail.com

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