Greater Indian Springs Community Chest
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Community Aid Form
Welcome to community aid.
GISCC is here to help
. Please fill out the form
completely
, and someone will contact you shortly.
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Date
*
Email
*
Referred by
*
Assistance Requested and Reason
*
If applying for assistance with AEP bill, have you applied for a balanced power bill?
*
Yes
No
Not applying for AEP assistance
Have you requested or received aid from Indian Springs Community Chest in the past?
*
Requested but was denied
Requested and was approved
Have never requested or received aid from Indian Springs Community Chest
Recommendations and Comments
*
For Utility Payments attach bill or account #, if available. For Rent/House Payments include name, phone #, and address of landlord.
Service Provider
*
Account Number
*
Amount
*
Name of Investigator 1
*
Name of Investigator 2
*
Executive Committee: Please complete the following information
Date
*
Action Taken
*
Case Number
*
Check Number
*
Approved By
*
Submit
Home
Budget
By-Laws
Community Aid Form
Community Calendar
Directors
Education Block Grant
Funding Application Form
Links
Make a Donation
Restricted
Previous Aid Requests (Restricted)
Contact