Request Form For General Assistance
Hello! 

Thank you for your application. 

Please fill out this application to the best of your ability. 

While we cannot guarantee assistance, we will make every effort to help you! Assistance is typically provided on a first-come, first-served basis.

If we are able to assist, our coordinator will contact you with 3-7 business days via email.. Thank you! 

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Asa’s Angels is Accepting Registrations from Families for General Assistance throughout the Calendar Year. 

This General Assistance Form is for Hardship Situations and Needs Such as: Beds, Bedding, Furniture, Dishes, Food, Toiletries, etc. 

Please note that Asa’s Angels is unable to provide gifts cards, or cash assistance towards Rent or Bill Pay.
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This Application is NOT FOR HOLIDAY ASSISTANCE: 

Please continue if you are completing this application for "General Calendar Year Assistance" only! 

Please DO NOT APPLY on this Form for Holiday Assistance Request. 
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Please note that organization is unable to Deliver, and that you will need to Arrange for Pick Up of Any Items: Is this Possible for you to pick up?

If Yes, Please Proceed Forward with Your Application!
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Required
PICKUP TERMS: 

Please Advise During the Pickup of Your Item, the Terms are as Follows:  

1. You MUST Bring Assistance with you to HELP Load Your Item 

2. You MUST Bring a Proper Vehicle to be Able to Transport Your Item 

3. You MUST Bring Your Own Straps to Secure Any Items for Safe Transporting.
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Pertaining to Any Used Items HOLD HARMLESS AGREEMENT: 

Your Donation Item from the Organization Maybe Gently Used, Are you OK with This? 

Your acceptance below acknowledges and agrees that you, along with any party who may claim through you; that you are hereby knowingly and voluntarily releasing and holding harmless: Century 21 Asa Cox Homes, Asa’s Angels, It’s Affiliates and All parties involved with the Donation of any Used Items.
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Asa’s Angels cannot guarantee that with your submitted registration for general assistance we will be able to assist. 

Depending on Need, Community Support & Donations Received into Our Office, if there is a possibility that we are able to assist, we will reach out to you ASAP, or within the next 3 to 7 business days via email!
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Required
Please complete the following application to its fullest extent; any registration missing information cannot be considered for assistance. 

Once your Application has been received in our Office you will receive an Confirmation Screen.

If you do not receive a confirmation screen, please EMAIL our office for confirmation of your application being received. Please DO NOT Re-Apply Again unless requested by the organization.
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Required
If you are Applying from the Columbus Area - PLEASE STOP HERE! 

Asa’s Angels is Over 3.5 Hours Away from Columbus. We are located in Northeast Ohio at 2709 N Ridge Rd Painesville, OH 44077 .. Our organization shows up online as if its an organization near the Columbus area, but that is NOT Correct.  If you are Located within Lake, Ashtabula or Geauga Counties, We are in your Service Area and Please continue with your Application.
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