Caseworker Application

This form is used by social service agencies or clergy to request an appointment for clients needing our help. The form consists of four sections: Caseworker, 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.

Verification – Please verify that your client is eligible to receive our help and really needs basic household items. We ask that verification include a visit to the client’s residence, if possible. This information is to be entered on the application under Guest Verification. In the Qualification section, the caseworker explains catastrophic events leading up to the loss of furniture or home for their client. Do not include finances or income. Income does not affect eligibility; catastrophic event does.

If more than one adult lives at the client’s address, the first and last names of each additional adult other than the client must be listed.

If the client is a minor, 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 changes. 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 client to a single appointment. Any change to that will be decided on a case-by-case basis. Clients should arrange for a truck or other furniture transport at least a week in advance to ensure availability on the day of their appointment.

Appointment requests are acted upon in a first-come first-serve basis. Before submitting the form, please review all entries for accuracy. Clients who have used our services previously are not eligible to return.