Client Assistance Application

  • Client Assistance Application Instructions

    Please assist individual (client) with this form, go over the Still Waters Ministries, Inc. Client Assistance Policy prior to filling this form. FOR ADMINISTRATIVE USE ONLY
  • Date Format: MM slash DD slash YYYY
  • Client and Family Requesting Assistance

  • This is the family representative and most likely the one requesting assistance.
  • Reasons and Details of Assistance Request

    Please be detailed and specific.
    Please select all that apply.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Submitter - Still Waters Staff Members or Associates (Only)

    Provide contact information of person submitting this form.