SPONSOR INFORMATION SECTION (person referring the Applicant(s) for assistance) Request Date: Request Completed by (Sponsor): Sponsor Phone #s: Home Work or Cell St Bernard's Church Member? YES ** Note: Please make sure you have discussed this request with the Applicant, and he/she has agreed to apply for assistance from PIC** DESCRIPTION OF NEED(S) - Be specific as to what this person(s) needs assistance with and date required (use additional page, if necessary). 1. When does assistance need to start? 2. When does assistance need to start? 3.When does assistance need to start? APPLICANT(S) IN NEED OF SERVICE(S): Applicant(s) Name(s): Age: Age: Address: City/State/Zip: Phone #s: If a family, please list names of children and any other adults in need plus their ages: