Index

More than 2,000 women apply for our assistance each year and we are primarily staffed by volunteers who work part-time and we are also being dependent on donations. As a result of these combined factors, this process takes time. By filling out this application, you acknowledge all of the following:

1. You are not filling out this application for anyone else.

2. That you are a single mother, a widow, OR the wife of someone that is currently deployed in the military.

3. You have a valid driver’s license that is in good standing.

4. You can provide documentation that you are a legal resident in the United States.

5. If you are applying for a car, there is no other vehicle currently titled in your name.

6. If you are applying for a car repair, the vehicle you are asking us to consider repairing is titled in your name only and you can provide proof that it is insured.

7. Approximately 10% of the women that apply with God's Garage receive our assistance.

8. If you qualify to receive a vehicle from us you will be required to transfer the car into your name and obtain insurance on that vehicle.

9. God's Garage has a zero tolerance policy. Inconsiderate, harassing or hostile behavior towards any volunteer or staff member, including the use of profanity, or other abusive actions, may result in the immediate denial of your application. We reserve the right to not serve anyone violating this policy.

10. All the information you are providing to us is confidential unless you have given us permission to disclose it.

I have read and understood the preceding disclaimer *

Date

12/5/2023

First and Middle Names as they appear on your Driver's License

Last Name as it appears on your Driver's License

Cell Phone Number

Email Address

Street Address

Street Address Line 2

City

County

State/Province

Zip/Postal

If your current name and address does not match your driver's license, please list the name and address on your driver's license for office use

DL#

State Issued

License plate of existing vehicle owned by applicant (leave blank if you do not have a car)

VIN of existing vehicle owned by applicant (leave blank if you do not have a car)

Miles driven per day

Date of Birth (2/15/1968 example)

Last 4 Digits of Social Secuirty Number

Number of kids living at home

Current Status

Single?

Married?

Divorced?

Widowed?

Separated?

If you were previously married, click this box if your divorce finalized.

Click this box if you currently employed.

Full time or part time?

Where?

Position or job

How did you hear about us?

Ages of Minor Children living with you

Any special needs children over the age of 17

Please list members of your household including age and relationship

Is this a car request or a request for service to your existing car?

Applicant story or current situation (Must be filled out completely or application will be rejected)

Have you been helped by God's Garage before?

What is your church affiliation, if any?

What is your monthly income?

Describe your car (year, make, model) and the service you are asking for

Current odometer reading/mileage

Are there special needs, such as wheelchair lift or access, or storage?

Is there anything else that you would like to tell us?

Please include 3 references with their working phone number, email address, and how you know this individual. Friend? Family? Professional?

By digitally signing below you verify that you are the applicant and you agree to the process and understand that if we cannot contact you, you will be removed from our list. If after signing your situation changes or you are no longer interested in the program, please let us know.

Digital Signature

This process could take several months, so please continue to pursue other sources of assistance