SVdP at the Shrine of the Immaculate Conception

The St. Vincent de Paul volunteers at the Shrine of the Immaculate Conception provides financial assistance and support to local neighbors in zip code 30315. If you reside in this area, complete the form below to request help.

We are a small group of volunteers and our ability to provide financial assistance is limited. To request assistance, please provide the following information. Once we receive your request, we will contact you within the next 2 days. As volunteers, we do not keep regular office hours.

May God bless you and may His peace be with you.

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Assistance Request Form

Please select the zip code where you live:*

If you do not reside in 30315 and are not a Shrine of the Immaculate Conception parishioner, you will not be eligible for assistance through the Shrine St. Vincent de Paul Conference. Please call the main St. Vincent de Paul Georgia assistance line at 678-892-6163 to be connected with a local Conference that may be able to assist you.

Head of Household Information

Name*

First Middle Last Maiden

SSN

Last 5 digits only

Date of Birth*

Email Address*

Address*

Street Address Address Line 2 City State ZIP Code

Apartment Complex Name

If applicable

Primary Phone*

Assistance Requested*

Please describe your request.*

You may include the circumstances that led you to this situation and other details pertaining to your need for assistance.

Please visit this website if you need help to apply for Food Stamps:

www.svdpgeorgia.org/snap-referral

Authorization for Release of Confidential Information

In consideration of the services to be undertaken or rendered on my behalf by the Society of St. Vincent de Paul, its members, agents or affiliated organizations (hereinafter referred to as “SVdP”), I, the undersigned, hereby authorize SVdP to receive, from any and all sources, and to release to any person or organization, any confidential information regarding me which may be necessary or useful to SVdP in relation to the services to be rendered. I hereby release SVdP from all liability in any way related to the receipt and/or release of said confidential information. I further understand that the release of this information does not guarantee that assistance will be provided, but that without such information my case cannot be presented to the Conference/Council for consideration.

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Request Assistance

Assistance Request Form

Head of Household Information

Please visit this website if you need help to apply for Food Stamps:

Authorization for Release of Confidential Information