Apply For Help

   

Questionnaire for Assistance

*Required
*Name of person in need:
DOB:

Address:
City:

State:
Zip:

*Email:
*Phone:

Summary of Need:
Are you receiving any other charitable aid?:

If yes, please explain:
How many people are in your household? Ages?:

Please provide information on your current job including salary for every working adult in the household.:
Are you affiliated with any member of WIN?:

If yes, in what capacity?:
Is there anyone who could attest to your situation and need? :

I attest that the above information is true.

Lake George Region for WIN, Inc. is a 501 (c) (3) non-profit corporation formed for the charitable purpose of aiding women and families living in Warren, Washington, Saratoga and Essex Counties who are in need of food, clothing, medical services, home fuel, transportation costs and shelter by providing financial help or guidance in obtaining much needed items for subsistence.