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We’re here to help.

At Middle Cross Mission, we’re here to provide practical, compassionate support to individuals and families in need. Whether you’re seeking financial help, mentorship, or community resources, you can apply for assistance through our secure and straightforward application. Our team reviews each request with care and confidentiality — we’re committed to walking beside you and helping you access the support you need.

Middle Cross Moments Application Form

Full Name

Phone

Email Address

Date of Birth

City, State, Zip

Preferred Contact Method Preferred Contact Method Text Email

Current Employment Status

Primary Source of Income

Dependents

What's happening right now that has made this season difficult?

What type of support do you need? What type of support do you need? Employment or Financial Transition Counseling or Mental Health Support Marriage or Family Restoration Legal or Civil Burden Health or Wellness Need Faith Encounter / Spiritual Renewal Other

* IF you selected other, please describe *

What does "getting back on track" look like to you?

Are you open to prayer or mentorship? Are you open to prayer or mentorship? Yes No

May we share your story publicly? (anonymously if preferred) May we share your story publicly? (anonymously if preferred) Yes No

Has faith played a role in your journey?

Is there a verse or message that encourages you?

15 + 8 =

I understand that submitting this form does not guarantee assistance. The Middle Cross Mission prayerfully reviews each request and may refer some needs to other resources. Support is offered at the organization’s discretion based on available funding and mission alignment.

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Middle Cross Moments Application Form

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