Application for Support

All applications are kept strictly confidential and reviewed with care and discretion.

SHALOM HEALING HEARTS FOUNDATION
APPLICATION FOR SUPPORT

Personal Information

First and Last Name *

Phone Number *

Email Address *

Address *

About Your Situation

Please share what you are currently facing and what led you to apply for support. *

Support Requested

(You may select more than one)

Spiritual guidance Emotional support Financial assistance for an urgent need I'm not sure — I'm seeking guidance

If you are requesting financial assistance, please briefly describe the need:

Financial Context

This foundation serves women who are currently unable to afford any form of support or care.

Does this apply to your current situation? *

Yes No Prefer not to answer

Is this request related to an urgent financial hardship? *

Yes No

Please share any additional information about your situation or financial circumstances that you feel is important for us to understand.

Additional Information

Is there anything else you would like us to know?

Acknowledgment & Understanding

Please read and acknowledge:

I understand that financial assistance is offered based on available charitable funds and assessed with care and discretion. I understand that submitting this application does not guarantee financial assistance. I confirm that the information I have shared is truthful to the best of my knowledge.

Signature *

Date *

Thank you for reaching out. Your request will be reviewed with compassion, confidentiality, and care.

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Shalom Healing Hearts

A faith-based non-profit organization dedicated to the emotional and spiritual restoration of women through Torah-based healing modalities.

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priscilla@shalomhealinghearts.org