Catholic Charities Gift Submission Thank you for your gift! "*" indicates required fields Catholic Charities is a 501(c3) organization, Tax ID#: 84-0686679.Donor InformationDonor* First Last Organization InformationName of Organization Contact Name First Last Additional InformationAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* May we connect you by Telephone Email Mail Gift InformationPlease list the quantity and description of all item(s) donated below.*Approx. value amount:* NameThis field is for validation purposes and should be left unchanged. "*" indicates required fields Name:* First Last Address that was impacted:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Number of members residing in your household: Was your home totally or partially destroyed? Total loss Partial loss Did you own or rent your home? Own Home Rent Home Was your property insured? Homeowner's insurance Homeowner's insurance (Underinsured) Renter's insurance Renter's insurance (Underinsured) No insurance Are you experiencing job loss or reduced hours? Job loss Reduced hours Unemployed/retired Home-based business (Reduced hours) Home-based business (Job loss) No Preferred method of contact: Phone call Email Text message No preference Do you belong to a Catholic parish? Yes No If yes, which parish? Have you started working with FEMA and/or other government agencies? Yes No If yes, which government agencies have you started working with? Type of dwelling: Single family home Apartment Mobile home Other What type of assistance are you seeking from Catholic Charities? Email:* Phone number:Please add any additional notes about your current situation and/or needs:Origin Intake DAC Parish Thank you for your information. We will be in touch shortly.Volunteer DataName First Last DAC Number Over the last 2 weeks, how often have you been bothered by the following problems?Little interest or pleasure in doing things Not at all Several days More than half the days Nearly every day Feeling down, depressed or hopeless Not at all Several days More than half the days Nearly every day Can we pray for you? Do you need any spiritual support/help in connecting? HiddenLast Modified Date CommentsThis field is for validation purposes and should be left unchanged.