610-351-1616

619 E Allen St Allentown, PA 18109

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Application

This form is used by non-profit social agencies (case workers) or clergy (clergy staff) to request an appointment for clients needing our help.  The form consists of four sections: case worker, agency, guest (client), and appointment. Make sure that each section is completed with current information. Omissions or incomplete information can result in delays or failure to secure a timely appointment for the client.

In Home Visits: You are asked to verify that your client is eligible to receive our help and really needs basic household items.  Meeting basic needs includes having a place to sit, a place to eat and a place to sleep. We ask that verification include a visit to the client’s residence. A “conversation with the client” does not satisfy this requirement.  This information is to be entered into the application under Guest Verification. Qualification is the section where the case worker explains catastrophic events leading up to the loss of furniture for their client.

If more than one adult lives at the client’s address, the first and last names of each adult must be provided. List other adults under residents.  (We do not schedule appointments for more than one individual at the same address.).

If the client is a minor (not an adult), the responsible adult caring for the child should be named as the client (on behalf of the minor).

Missed Appointments:  Anyone failing to keep a scheduled appointment (and who does not contact us in advance) will not be rescheduled. Missed appointments deny others the opportunity to get timely help.

Client’s Phone Number: The client’s phone number is needed so we can contact them directly in the event of last minute schedule change. If you enter a phone number other than the client’s, please explain the reason in the “Comment” section.

It is our policy to limit each guest to a single appointment. If guests are unable to remove selected items at the conclusion of the appointment, a follow up appointment will be scheduled so that transportation can be arranged. In the event that basic items on the client’s list were not available, but are then available during the follow up appointment, those items will be offered and, if selected, must be removed immediately.

Appointment requests are generally acted upon within a few days. Before submitting the form, please review all entries for accuracy. Incomplete answers can result in delays or failure to secure a timely appointment for the client. Clients who have used our services previously are not eligible to return.