APPLICATION FOR ASSISTANCE

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This application is for the purpose of evaluating and determining the level of assistance that (a) caregiving grandparent(s) may be provided. Completion of this application is no guarantees that assistance will be provided by Love You Lots. Every application will go through a vetting process which will determine if the request for assistance is approved. Proof of custody is required. Also, additional documentation may need to be submitted, allowing for an informed decision to be rendered.

Email *

Name *

First, Middle, Last

Maiden Name (if applicable)

Marital Status *

(If spouse or domestic partner lives at address below, please complete the Information For Spouse/Domestic Partner section.)

Date of Birth *

YYYY

Address *

Street Number, Apt/Unit, City, State, Zip Code

Contact Phone Number *

###-###-####

Are you currently employed? *

Do you currently receive private, state, and/or federal assistance? *

If Yes to either, please provide details, such as the source, amount, frequency

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