Crisis Assitance

His Hands and Feet
Matthew 25:35-36

Local partnering churches and businesses volunteer their funds to assist those in need who meet certain qualifications. If you are in LaSalle Parish, Louisiana and seeking assistance, please fill out the contact form below in detail. If you would like to help families in need, please see our giving page.

LaSalle Ministerial Alliance
Crisis Assistance Form

To qualify you must 1.) Be a resident of LaSalle Parish, Louisiana. 2.) Provide a valid crisis request such as medical emergency, job loss, housing loss, relationship status change, childcare issues, etc. 3.) Provide proof of income for the following month or job application and a balanced financial plan. 4.) Provide your bill or landlord contact information, as we pay services directly. 5.) Provide a valid personal contact such a family member or friend who can attest to your situation.

NOTE: For food assistance the Ministerial Alliance works with the LaSalle Baptist Mission House in Jena, LA.

First Name

Last Name

Birthdate

Phone Number

Gender

Marital Status

What specific need or challenge are you facing right now?

How urgent is the situation, and what will happen if it’s not addressed soon?

How exactly will the money be used? (e.g., rent, medical bills, food)

What amount is needed to resolve the issue?

Can you provide documentation (e.g., bills, invoices, proof of need)?

Please email bills to lasalle.alliance@gmail.com or deliver to Sanctuary Family Worship Center, 1570 Jackson Street, Jena LA (mailbox drop-off between buildings).

Housing Situation

Address (if applicable)

Apartment, suite, etc.

City

State

Zip/Postal Code

Please list every person in your home and ages

Please check all that apply (these do not disqualify)

Myself or someone in my home is disabled and receiving SSDI

Myself or someone in my home is receiving Food Stamps or WIC

Myself or someone in my home is receiving assistance from the Mission House

Myself or someone in my home is receiving child supprt.

Myself or someone in my home is a veteran

Please check all that apply?

I have recently applied for government assistance

I have recently applied to local church for assistance

I have contacted Work Force for job assistance

I have recently applied for disability

Please list any employment and phone numbers from last 5 years

Please list your current monthly income from all sources (Jobs, Disability, Child Support, Food Stamps, WIC, etc)

Please list your current monthly expenses from all sources (Housing, Electric, Water, Gas, Loans, Credit Cards, Child Support, Insurance, Phone, Internet, Cable, etc.)

Do you have a home church in LaSalle Parish?

Would you like to enroll in financial or family coaching in order to receive more assistance?

First Name (of Closest Supporter)

Last Name (of Closest Supporter)

Phone Number (of Closest Supporter)

Signature

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