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DWC Assistance Fund Request Form

Mary Kirkpatrick Family Assistance Fund Request
Address:
Address:
City
State/Province
Zip/Postal
Mailing Address:
Mailing Address:
City
State/Province
Zip/Postal
Marital Status:
Are you currently unemployed?:
Are you receiving unemployment assistance?
Are you a non-profit organization?:

Non-Profit Organization Information

Organization Address:
Organization Address:
City
State/Province
Zip/Postal

Assistance Requested

If your request includes assistance for rent/mortgage or utility bills, please email copies of mortgage / utilities bills and other supporting documents using the email link below.
Monthly rent/mortgage:
Electric Bill
Water Bill
Gas Bill
Will you be sending supporting information?
Have you requested assistance from another organization?
Please Note: All Applicants must reside in Walton or Okaloosa Counties, unless Executive Board approves and are subject to the same review process. All requests must be reviewed and approved by the Destin Woman’s Club “DWC” Executive Board, and will be treated with the utmost confidentiality. Although the DWC Executive Board strives to reach each decision with full consideration for each request, regardless of Applicant’s gender, age, race or religion, and in a very timely manner, additional information may need to be considered before such decision can be determined. Your patience & understanding is appreciated. DWC is a 501(c)(3) equal opportunity organization comprised of all volunteer women.
Revised August 2023