Disclaimer: All information submitted to Helping Hands with Helping Hearts is confidential. Please answer the questions to the best of your ability. The more information you provide the better we will be able to assess needs in a timely and just manner.

As cars are donated to our organization we will review applications on file

and make a determinization the greatest current need.

This organization is run by volunteers with a heart to serve by providing help to those in need so plaese be patient while you wait.

If you are selected to receive a vehicle:

You MUST obtain insurance for the vehicle, have a valid Texas Driver’s License and have the ability transfer the vehicle into your name before you can take possession of the vehicle.

If you are selected to receive a repair:

An appointment time will need to be set to evaluate what needs to be repaired.

Helping Hands is run by volunteers with a heart to serve by providing help to those in need so please be patient while you wait.

Application for Assistance

Application Type *

Repair Vehicle

Date *

Name *

Address *

Phone *

Email *

Do you have children *

If so what are their ages *

Emergency Contact *

Relationship *

How did you hear about us *

Referred by *

Are you Employed *

How long have you been Employed *

Are you going to school *

When will you graduate *

Do you have any income *

Do you have a driver’s license *

State *

DL *

Do you have money for gas *

Can you provide car insurance *

Do you currently have any vehicle citations parking tickets etc *

Please explain your current situation *

What other organizations have you worked *

Why do you feel you need our services *

What are your goals *

Would you be willing to meet with us *

Requests for repairs please include the following information
Make *
Model *
Year *
Issue *

If you are selected to receive a vehicle:

You MUST obtain insurance for the vehicle, have a valid Texas Driver’s License and have the ability transfer the vehicle into your name before you can take possession of the vehicle.

Helping Hands is run by volunteers with a heart to serve by providing help to those in need so please be patient while you wait.

Additional Notes:

Disclaimer: All information submitted to Helping Hands with Helping Hearts is confidential. Please answer the questions to the best of your ability. The more information you provide the better we will be able to assess needs in a timely and just manner.

If you are selected to receive a vehicle:

If you are selected to receive a repair:

Requests for repairs please include the following information

If you are selected to receive a vehicle:

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