Providing a Bridge on
the Road to Success
Contact Us     Initial Application


Please read the Who Can We Help page and the please read the page for the specific Here to Help program that addresses your emergency need.

If, after reading this information, you believe your situation qualifies for assistance from Here to Help then please fill out the Initial Application below and click the 'Submit Application' button.

Please provide as much information as possible so we can determine if you qualify for help. You are not limited by the size of the answer boxes below as they will expand.


Required Fields

First name  
Last name  
Phone number  
Email address  
(you will need to create an email if you donít
have one so we can communicate with you further)
Street address  
State   MI
Wayne Oakland
Date of Birth  
Name of the Here to Help program that deals with your emergency situation.  
Please fully explain the circumstances of your emergency situation. Include how and why this emergency arose and how, if help is provided, this situation will not occur again in the future. Please answer with as much detail as possible.  
Please explain how your situation meets the specific requirements for our program that helps with your emergency. DO NOT send the requested information for that program at the present time. Please only explain how you feel you qualify.  
Please state all sources and total amounts of monthly income for the entire household. Please state the amount from each source for an entire month.  
Please state who referred you to the Foundation.  

Please note the information throughout the website that we operate only in Wayne and Oakland County in Michigan.

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