{"id":1062,"date":"2025-11-04T20:02:26","date_gmt":"2025-11-04T20:02:26","guid":{"rendered":"https:\/\/washingtonstreetbaptist.org\/?page_id=1062"},"modified":"2026-02-13T14:05:50","modified_gmt":"2026-02-13T14:05:50","slug":"w-a-s-h-ministry-form","status":"publish","type":"page","link":"https:\/\/washingtonstreetbaptist.org\/index.php\/w-a-s-h-ministry-form\/","title":{"rendered":"Benevolence Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1062\" class=\"elementor elementor-1062\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;}\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1912c45 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1912c45\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2307c04\" data-id=\"2307c04\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e01a054 elementor-widget elementor-widget-heading\" data-id=\"e01a054\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Welcome to the Washington Street Baptist Church W.A.S.H. Ministry! <\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-028bb9a elementor-widget elementor-widget-text-editor\" data-id=\"028bb9a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\"><strong>Our hours are Monday and Fridays from 9:30AM &#8211; 1 :00PM<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-de63b37 elementor-widget elementor-widget-text-editor\" data-id=\"de63b37\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>In order for your application to be considered, you must provide us with a valid driver&#8217;s license\/identification card, social security card and proof of all income for your household. <br \/>Assistance with utility bills or a rental eviction will require the eviction letter to be in the applicant&#8217;s name and the applicant must be present.<br \/><br \/><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-18bddc5 elementor-widget elementor-widget-text-editor\" data-id=\"18bddc5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>*<strong><em>Giving false or omitting information on your application will be automatic grounds for denial.<\/em><\/strong><\/p><p><strong>\u00a0 \u00a0 \u00a0 \u00a0<span style=\"text-decoration: underline;\"> Here for food?<\/span><\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5d2c011 elementor-widget elementor-widget-text-editor\" data-id=\"5d2c011\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Requirements:<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-ef530b5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ef530b5\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-de436c5\" data-id=\"de436c5\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-3c43d2d\" data-id=\"3c43d2d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fefe706 elementor-widget elementor-widget-text-editor\" data-id=\"fefe706\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>1. Proof of household income including SNAP benefits.<br \/>2. Eligible ONCE every 60 days.<br \/>3. Must have picture ID or a driver&#8217;s license.<br \/>4. You must have social security cards for household members you list on your application.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-77a0662\" data-id=\"77a0662\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-60b6c2d elementor-widget elementor-widget-text-editor\" data-id=\"60b6c2d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>* Food pantry bag contents are based on current availability bags may vary.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6abab99 elementor-widget elementor-widget-text-editor\" data-id=\"6abab99\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"text-decoration: underline;\"><strong>Here for assistance with your utility bill?<\/strong><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2652e6a elementor-widget elementor-widget-text-editor\" data-id=\"2652e6a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Requirements:<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-9486b3c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9486b3c\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-b2b5fa0\" data-id=\"b2b5fa0\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-fa3b0ed\" data-id=\"fa3b0ed\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-43409d4 elementor-widget elementor-widget-text-editor\" data-id=\"43409d4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>1. The utility bill must be in applicant&#8217;s name and applicant must be present.<br \/>2. Proof of income of all household members.<br \/>3. If approved, you may not be eligible to apply for financial assistance until after 1 year .<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-b131ede\" data-id=\"b131ede\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-3fa34cf elementor-widget elementor-widget-text-editor\" data-id=\"3fa34cf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"text-decoration: underline;\"><strong>Here for assistance with a rental eviction?<\/strong> <\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3e365fa elementor-widget elementor-widget-text-editor\" data-id=\"3e365fa\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Requirements:<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a9410b5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a9410b5\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7e022b9\" data-id=\"7e022b9\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-8ea7c1d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8ea7c1d\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-4b71cc7\" data-id=\"4b71cc7\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-693bc0c\" data-id=\"693bc0c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-db08074 elementor-widget elementor-widget-text-editor\" data-id=\"db08074\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>1. Must have a 10 or 14-d ay notice to vacant letter on the business letterhead.<br \/>2. Landlord must be able to be verified by the McCracken County Property Valuation Department.<br \/>3. The notice must be in the applicant&#8217;s name and applicant must be present.<br \/>4. If approved, assistance is only available ONCE a year.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-d7535ec\" data-id=\"d7535ec\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7ae9f9e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7ae9f9e\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7e89a0d\" data-id=\"7e89a0d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ae2c73b elementor-widget elementor-widget-html\" data-id=\"ae2c73b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-1104\"><form id=\"wpforms-form-1104\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1104\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1062\" data-token=\"0b96d5e5caa6855964aade347004e075\" data-token-time=\"1776438146\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Benevolence Form<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1104-field_8-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"8\"><label class=\"wpforms-field-label\">Date \/ Time <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1104-field_8\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][8][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-1104-field_8\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-1104-field_8-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][8][time]\" required><label for=\"wpforms-1104-field_8-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/div><div id=\"wpforms-1104-field_5-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_5\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1104-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1104-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_18\">What is your immediate need today?<\/label><input type=\"text\" id=\"wpforms-1104-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" ><\/div><div id=\"wpforms-1104-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_19\">How did you hear about us?<\/label><input type=\"text\" id=\"wpforms-1104-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" ><\/div><div id=\"wpforms-1104-field_20-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-type=\"checkbox\" data-field-id=\"20\"><label class=\"wpforms-field-label\">Are you a member of WSBC<\/label><ul id=\"wpforms-1104-field_20\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_20_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][20][]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_20_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_20_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][20][]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_20_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-1104-field_11-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"11\"><h3 id=\"wpforms-1104-field_11\">APPLICANT INFORMATION<\/h3><\/div><div id=\"wpforms-1104-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"2\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1104-field_2\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][2][first]\" required><label for=\"wpforms-1104-field_2\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1104-field_2-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][2][last]\" required><label for=\"wpforms-1104-field_2-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1104-field_12-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"12\"><label class=\"wpforms-field-label\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1104-field_12\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][12][address1]\" ><label for=\"wpforms-1104-field_12\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1104-field_12-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][12][address2]\" ><label for=\"wpforms-1104-field_12-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1104-field_12-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][12][city]\" ><label for=\"wpforms-1104-field_12-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1104-field_12-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][12][state]\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-1104-field_12-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1104-field_12-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][12][postal]\" ><label for=\"wpforms-1104-field_12-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-1104-field_13-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_13\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1104-field_13\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][13][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-1104-field_6-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_6\">SS# <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1104-field_6\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][6]\" aria-label=\"SS#\" required><\/div><div id=\"wpforms-1104-field_14-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"14\"><label class=\"wpforms-field-label\">Martial Status <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1104-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_14_1\" name=\"wpforms[fields][14]\" value=\"Single\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_14_1\">Single<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_14_2\" name=\"wpforms[fields][14]\" value=\"Married\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_14_2\">Married<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_14_3\" name=\"wpforms[fields][14]\" value=\"Divorced\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_14_3\">Divorced<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_14_4\" name=\"wpforms[fields][14]\" value=\"Separated\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_14_4\">Separated<\/label><\/li><\/ul><\/div><div id=\"wpforms-1104-field_15-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_15\">Drivers License # <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1104-field_15\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][15]\" aria-label=\"Drivers License #\" required><\/div><div id=\"wpforms-1104-field_16-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_16\">Best Contact Number<\/label><input type=\"tel\" id=\"wpforms-1104-field_16\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][16]\" aria-label=\"Best Contact Number\" ><\/div><div id=\"wpforms-1104-field_10-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"10\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_21\">First Name<\/label><input type=\"text\" id=\"wpforms-1104-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_22\">Last Name<\/label><input type=\"text\" id=\"wpforms-1104-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_24-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-type=\"checkbox\" data-field-id=\"24\"><label class=\"wpforms-field-label\">Gender<\/label><ul id=\"wpforms-1104-field_24\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_24_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][24][]\" value=\"M\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_24_1\">M<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_24_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][24][]\" value=\"F\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_24_2\">F<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_25-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_25\">DOB\/Age<\/label><input type=\"number\" id=\"wpforms-1104-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" step=\"any\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_26\">First Name (copy)<\/label><input type=\"text\" id=\"wpforms-1104-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_27\">Last Name<\/label><input type=\"text\" id=\"wpforms-1104-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_28-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-type=\"checkbox\" data-field-id=\"28\"><label class=\"wpforms-field-label\">Gender<\/label><ul id=\"wpforms-1104-field_28\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_28_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][28][]\" value=\"M\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_28_1\">M<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_28_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][28][]\" value=\"F\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_28_2\">F<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_29-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_29\">DOB\/Age<\/label><input type=\"number\" id=\"wpforms-1104-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\" step=\"any\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_30\">First Name (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-1104-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_31\">Last Name<\/label><input type=\"text\" id=\"wpforms-1104-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_32-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-type=\"checkbox\" data-field-id=\"32\"><label class=\"wpforms-field-label\">Gender<\/label><ul id=\"wpforms-1104-field_32\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_32_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][32][]\" value=\"M\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_32_1\">M<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_32_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][32][]\" value=\"F\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_32_2\">F<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_33-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_33\">DOB\/Age<\/label><input type=\"number\" id=\"wpforms-1104-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\" step=\"any\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_34\">First Name (copy) (copy) (copy)<\/label><input type=\"text\" id=\"wpforms-1104-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_35-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_35\">Last Name<\/label><input type=\"text\" id=\"wpforms-1104-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_36-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-type=\"checkbox\" data-field-id=\"36\"><label class=\"wpforms-field-label\">Gender<\/label><ul id=\"wpforms-1104-field_36\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_36_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][36][]\" value=\"M\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_36_1\">M<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1104-field_36_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][36][]\" value=\"F\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_36_2\">F<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_37-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_37\">DOB\/Age<\/label><input type=\"number\" id=\"wpforms-1104-field_37\" class=\"wpforms-field-medium\" name=\"wpforms[fields][37]\" step=\"any\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1104-field_55-container\" class=\"wpforms-field wpforms-field-divider wpforms-field-divider-hide_line\" data-field-type=\"divider\" data-field-id=\"55\"><h3 id=\"wpforms-1104-field_55\">False OR missing information is grounds for denial of assistance<\/h3><\/div><div id=\"wpforms-1104-field_57-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"57\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tApplicant&#039;s Income\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1104-field_58-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_58\">Employer<\/label><input type=\"text\" id=\"wpforms-1104-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1104-field_59-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-type=\"radio\" data-field-id=\"59\"><ul id=\"wpforms-1104-field_59\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_59_1\" name=\"wpforms[fields][59]\" value=\"Full Time\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_59_1\">Full Time<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_59_2\" name=\"wpforms[fields][59]\" value=\"Part Time\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_59_2\">Part Time<\/label><\/li><\/ul><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1104-field_60-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_60\">Gross Wages<\/label><input type=\"number\" id=\"wpforms-1104-field_60\" class=\"wpforms-field-medium\" name=\"wpforms[fields][60]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1104-field_61-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-type=\"radio\" data-field-id=\"61\"><ul id=\"wpforms-1104-field_61\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_61_1\" name=\"wpforms[fields][61]\" value=\"Weekly\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_61_1\">Weekly<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_61_2\" name=\"wpforms[fields][61]\" value=\"Bi-weekly\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_61_2\">Bi-weekly<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_61_4\" name=\"wpforms[fields][61]\" value=\"Monthly\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_61_4\">Monthly<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1104-field_38-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"38\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_62-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_62\">Unemployment<\/label><input type=\"number\" id=\"wpforms-1104-field_62\" class=\"wpforms-field-medium\" name=\"wpforms[fields][62]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_65-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_65\">SSA<\/label><input type=\"number\" id=\"wpforms-1104-field_65\" class=\"wpforms-field-medium\" name=\"wpforms[fields][65]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_63-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_63\">SSI<\/label><input type=\"number\" id=\"wpforms-1104-field_63\" class=\"wpforms-field-medium\" name=\"wpforms[fields][63]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_64-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_64\">SSDI<\/label><input type=\"number\" id=\"wpforms-1104-field_64\" class=\"wpforms-field-medium\" name=\"wpforms[fields][64]\" step=\"any\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_66-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_66\">Workman Comp<\/label><input type=\"number\" id=\"wpforms-1104-field_66\" class=\"wpforms-field-medium\" name=\"wpforms[fields][66]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_67-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_67\">KTAP<\/label><input type=\"number\" id=\"wpforms-1104-field_67\" class=\"wpforms-field-medium\" name=\"wpforms[fields][67]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_68-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_68\">SNAP<\/label><input type=\"number\" id=\"wpforms-1104-field_68\" class=\"wpforms-field-medium\" name=\"wpforms[fields][68]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><\/div><\/div><\/div><div id=\"wpforms-1104-field_70-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"70\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tSpouse or Significant Other&#039;s Income\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1104-field_71-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_71\">Employer<\/label><input type=\"text\" id=\"wpforms-1104-field_71\" class=\"wpforms-field-medium\" name=\"wpforms[fields][71]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1104-field_73-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-type=\"radio\" data-field-id=\"73\"><ul id=\"wpforms-1104-field_73\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_73_1\" name=\"wpforms[fields][73]\" value=\"Full Time\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_73_1\">Full Time<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_73_2\" name=\"wpforms[fields][73]\" value=\"Part Time\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_73_2\">Part Time<\/label><\/li><\/ul><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1104-field_72-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"72\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_72\">Gross Wages<\/label><input type=\"number\" id=\"wpforms-1104-field_72\" class=\"wpforms-field-medium\" name=\"wpforms[fields][72]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1104-field_74-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-type=\"radio\" data-field-id=\"74\"><ul id=\"wpforms-1104-field_74\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_74_1\" name=\"wpforms[fields][74]\" value=\"Weekly\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_74_1\">Weekly<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_74_2\" name=\"wpforms[fields][74]\" value=\"Bi-weekly\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_74_2\">Bi-weekly<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1104-field_74_4\" name=\"wpforms[fields][74]\" value=\"Monthly\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1104-field_74_4\">Monthly<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><\/div>\t\t<div id=\"wpforms-1104-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1104-field_1\" >household you Name<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1104-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1104-field_75-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"75\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_76-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_76\">Unemployment<\/label><input type=\"number\" id=\"wpforms-1104-field_76\" class=\"wpforms-field-medium\" name=\"wpforms[fields][76]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_78-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_78\">SSA<\/label><input type=\"number\" id=\"wpforms-1104-field_78\" class=\"wpforms-field-medium\" name=\"wpforms[fields][78]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_80-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_80\">SSI<\/label><input type=\"number\" id=\"wpforms-1104-field_80\" class=\"wpforms-field-medium\" name=\"wpforms[fields][80]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_82-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"82\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_82\">SSDI<\/label><input type=\"number\" id=\"wpforms-1104-field_82\" class=\"wpforms-field-medium\" name=\"wpforms[fields][82]\" step=\"any\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_77-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_77\">Workman Comp<\/label><input type=\"number\" id=\"wpforms-1104-field_77\" class=\"wpforms-field-medium\" name=\"wpforms[fields][77]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_79-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_79\">KTAP<\/label><input type=\"number\" id=\"wpforms-1104-field_79\" class=\"wpforms-field-medium\" name=\"wpforms[fields][79]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1104-field_81-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"81\"><label class=\"wpforms-field-label\" for=\"wpforms-1104-field_81\">SNAP<\/label><input type=\"number\" id=\"wpforms-1104-field_81\" class=\"wpforms-field-medium\" name=\"wpforms[fields][81]\" step=\"any\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><\/div><\/div><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1104-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1104-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1104-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1104\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/pages\/1062\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1104\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/washingtonstreetbaptist.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-52f572d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"52f572d\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-20f94cb\" data-id=\"20f94cb\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-31d7fca elementor-align-center elementor-widget elementor-widget-button\" data-id=\"31d7fca\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/washingtonstreetbaptist.org\/wp-content\/uploads\/2026\/02\/Benevolence-Application-Form.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Download Benevolence Form<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Welcome to the Washington Street Baptist Church W.A.S.H. Ministry! Our hours are Monday and Fridays from 9:30AM &#8211; 1 :00PM In order for your application to be considered, you must provide us with a valid driver&#8217;s license\/identification card, social security card and proof of all income for your household. Assistance with utility bills or a [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"boxed","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"disabled","ast-main-header-display":"disabled","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"disabled","site-post-title":"","ast-breadcrumbs-content":"disabled","ast-featured-img":"disabled","footer-sml-layout":"disabled","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_vp_format_video_url":"","_vp_image_focal_point":[],"footnotes":""},"class_list":["post-1062","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/pages\/1062","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/comments?post=1062"}],"version-history":[{"count":35,"href":"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/pages\/1062\/revisions"}],"predecessor-version":[{"id":1312,"href":"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/pages\/1062\/revisions\/1312"}],"wp:attachment":[{"href":"https:\/\/washingtonstreetbaptist.org\/index.php\/wp-json\/wp\/v2\/media?parent=1062"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}