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Request for Assistance Form

Please complete the form below to request free hygiene items for your family with young children and/or students in Wake, Durham, and Johnston counties. Be sure to answer all questions; incomplete response will delay your application. Requests are limited to once per household every six months and priority is given to first time requests.

Address
Gender & Race
Marital Status
Single
Married
Divorced
Widowed
Category
Family with Young Children - No Students
Family with Student(s)
College Student
Teacher
Is anyone in your household employed?
Yes
No

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SOYMILK & HOPE * PO BOX 14996 * Raleigh, NC 27620

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