Benevolence Request Form

Local Applicants Only

Local Applicants Only

Our services are only available to residents of East Volusia and Flagler Counties in Florida.

All other applicants can seek assistance through the United Way portal https://www.211.org/

Application Details

Date of Request

Person filling out form

Name

Address

Date of Birth

Phone

How did you hear about Salty Families?

Briefly describe the need and amount being requested:

Employer?

Do you attend Salty?

Please note that someone from our benevolence team will be contacting you. Submitting this form does not guarantee that funds will be dispersed. If funds are dispersed, it will take approximately 7-10 days to receive a check.

Description

Please fill out this form and click submit.

Benevolence Request Form

Description

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