Basic Review + Vetting - Service

In reviewing your request for service, we will need the following information:

Please respond to this form within the next 48 hours. Failure to do so may result in your application being closed.

You need to answer ALL the questions on this form. If they are Not Applicable–please indicate “NA” or your application will be denied.

Name(Required)

First Middle Last

Phone(Required)

Email(Required)

Gender(Required)

Male

Female

Are you still in need of assistance?(Required)

Yes

No

Which volunteer have you been communicating with over email?(Required)

Make sure you double-check what you select here, as this form will be sent to them upon completion.

Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code

At this time, are you married, single, divorced, widowed, separated, common law husband or have a live-in significant other?(Required)

If you answered other, please explain:(Required)

Do you have a valid driver's license?(Required)

Yes

No

Upload a copy of your driver's license:(Required)

Max. file size: 100 MB.

A valid driver's license is required for assistance through God's Garage

Driver's License Number:(Required)

Are you a veteran?(Required)

Yes

No

DD214(Required)

Max. file size: 100 MB.

Has your divorce been finalized?(Required)

Yes

No

Divorce Decree(Required)

Max. file size: 100 MB.

Do you have dependent children living in your household?(Required)

Yes

No

Please list names and ages of children living in your household:(Required)

Are you, and/or any of your children living in your home, disabled or ill?(Required)

Yes

No

Please go more into detail on what disabilities or illnesses you and/or your children have:(Required)

Who lives in your household?(Required)

Are there any other adults living with you?(Required)

Yes

No

If yes, what are their names, ages and your relationship to them?(Required)

Do you have local support? (Finance, husband, parents, siblings, grandparents...)(Required)

What is your income?(Required)

Do you work?(Required)

Yes

No

Where do you work?(Required)

Who is your immediate supervisor?(Required)

Name and contact information preferred.

Do you attend college or trade school?(Required)

Yes

No

If you attend college or trade school, where?(Required)

Provide the VIN / Year / Make / Model of your vehicle:(Required)

Required Information: VIN / Year / Make / Model

What is wrong with your vehicle? Provide as much detail as possible:(Required)

If you have had your vehicle evaluated at a shop, please provide that here:

Drop files here or

Max. file size: 100 MB.

A picture of this is acceptable.

Insurance for owned/registered vehicle:(Required)

Drop files here or

Max. file size: 100 MB.

A picture of this is acceptable.

Registration for owned/registered vehicle:(Required)

Drop files here or

Max. file size: 100 MB.

A picture of this is acceptable.

Is there any new information regarding your application you would like to add at this time?(Required)