Hope Community Church
Car Repair Request Form
Preferred Phone Number
Do you attend Hope Community Church?
NOTE: Answering "No" does not disqualify you from receiving assistance.
Which campus do you attend?
How long have you been attending?
How did you hear about Hope's car ministry? Who referred you?
Have you received help from the Care Ministry in the last 12 months? (including financial assistance with bills or counseling)
Please provide additional information regarding your specific situation:
Do Not Fill This Out