top of page

Home
- Mission
Client Intake
Services
About
- Our Stories
- Board of Directors
Support Us
- Join the Team
- Become a Sponsor
Blog
Events
Contact
More...

Use tab to navigate through the menu items.

Donate

Contact information

First name*

Last name*

Birthday

Month

Day

Year

Phone

Best way to contact you

Call

E-mail

Text

Home address (street, city, ZIP)

Household information

All household members

Names and ages of all household members
Relationship of each person to you

Primary language spoken at home

Do you have access to transportation?

Yes

Current situation and needs

Marital Status

What kind of help are you requesting?

Housing

Food

Clothing

Utilities

Immigration support

School support

Other

Please briefly describe your current situation and what you need most right now.

If requesting rent, please provide amount including name, address, phone number, and email of landlord.

If requesting utility payment, please provide amount including name of utility company and account number.

Is this an emergency? (yes/no; if yes, please explain)

How did you hear about Anchor of Hope?

Eligibility / background

Do you have any income coming into the household? (yes/no; if yes, source and approximate monthly amount)

Employment and Employer Contact Information for Verification

What County do you live in?

Current immigration status (optional, short description)

Consent and follow‑up

I give permission for Anchor of Hope to contact me about this request.

Yes

I understand that submitting this form does not guarantee assistance and that services depend on availability and eligibility.

Anchor of Hope

“The unselfish effort to bring cheer to others will be the beginning of a happier life for ourselves.” – Helen Keller

Email: anchorofhopeinc@outlook.com

Contact: Ann-Marie Potemski / President

Phone: (330) 241-7091

Registered Charity: 92-2732339

Quick Links

bottom of page