Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Contact Method

Call

Email

Text

Support Needed *

Type of Support Needed

Access to Health Care

Food and Nutrition Assistance

Emergency Crisis Relief

Clothing and Household Items

Community Resource Referrals

Our Privacy Policy *

By checking this box, I acknowledge that I have read and agree to the Privacy Policy of Selfless Hands Foundation. I understand and consent to the collection, use, and disclosure of my personal information as described in the Privacy Policy. I understand that my personal information will be handled in accordance with applicable data protection laws and regulations.

I have read and agree to the Privacy Policy.

Consent to Share Information *

By submitting this support request form, you acknowledge and give your consent for Selfless Hands Foundation to collect, use, and share the information provided for the purpose of assessing your eligibility for assistance and providing the necessary support. We understand the importance of safeguarding your personal information and assure you that any data collected will be handled in accordance with our privacy policy. We will only share your information with trusted partners, service providers, or relevant organizations involved in delivering the requested support services. The information you provide may include personal details such as your name, contact information, demographics, and specific support needs. This information will be used solely for the purpose of evaluating your eligibility for assistance and tailoring our support services to meet your needs. Please note that by providing your consent, you understand that sharing certain information may be necessary to access certain support services. However, we will always strive to protect your privacy and ensure that your personal information is handled with the utmost care and in compliance with applicable data protection laws. If you have any concerns or questions regarding the collection, use, or sharing of your information, please contact us directly. Your trust and confidence in our organization are of utmost importance to us. Thank you for your understanding and cooperation in supporting our mission to provide essential support services to those in need.

I hereby give my consent for Selfless Hands Foundation to collect, use, and share the information provided in accordance with the description above.