World-Wide Lighthouse Missions, Inc.


Request For Help - Self
Eligibility Requirements: Eligibility requirements include, but are not limited to: Financial inability to acquire requested items Inability to receive state assistance for requested items Head of household employed, actively seeking employment, or proof of valid inability to work At least one professional reference for verification of the above Preferential eligibility provided to those being assisted by WWLM Partner Agencies (See Agencies) Please Note: Financial Assistance is not provided by WWLM.
By clicking "I agree" below, you are indicating that you have read and agree to the Eligibility Requirements of the WWLM Donation Center.
Do you agree with the terms above? *	I agree
First Name *
Last Name *
Email *
Phone *
Referral Source *
Item(s) Requested *
Help us understand your reason for the requested item(s) free of charge *
Employed? *
Insured? *
If insured, does your insurance cover the item(s) requested?
Receiving Financial Assistance? *
Specify Type of Financial Assistance
References
PROFESSIONAL OR PASTORAL REFERENCES ONLY. One reference is mandatory.
Reference *
Reference Name *
Reference Organization Name
Reference Phone Number *
Reference Email *

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