Application for Assistance

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Application for assistance

Complete this form to sign up for our local, mobile food pantry and community closet serving Perris, Moreno Valley, and Menifee!
If you need help filling out this form, please call (951) 703-3716, and leave a message, or email info@legacyshelters.org.
Please note that our rental assistance program has been discontinued.

* Indicates required field

Name *

First

Last

Street Address *

City *

Zip Code *

Phone Number *

Email *

What, if any, type of aid are you requesting from Legacy Shelters or one of their partners? (Select all that apply.) *

Employment Food pantry Community closet (i.e., household items, clothing &/or other necessities) Medical Housing Rental assistance Other

For community closet, please specify *

For other, please specify *

Do you need help obtaining an I.D., Driver's License or Social Security Card? *

Yes No Unsure

Including yourself, how many people slept in the same place with you last night? *

How many children under 18 are there in your household who are sleeping in the same location? *

What is the current problem you are experiencing? (You may list more than one.) *

For reporting purposes only, please specify your race: *

Asian or Asian American Black or African American Hispanic/Latino Native American Pacific Islander White Other Unknown/decline to specify

Are you interested in being partnered with a Legacy Shelter's accountability partner or mentor? *

Yes, please No, thank you

You may upload applicable documentation here: *

Max file size: 20MB

Please accept *

I certify that the following information is true and authorize Legacy Shelters to verify any details I have voluntarily provided.

Typed Signature Required: *

Submit

Who we are
What We Do
Contact
2-1-1 Directory