IRS-Approved 501(c)3  ·  Lady Lake, Florida info@lionheartshouseofbread.com
Lionheart's House of Bread Refuge  ·  Respite  ·  Retreat  ·  Revival
PO Box 145, Lady Lake, FL 32158
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Special Needs Family
Assistance Application

Take your time. Every question here helps us understand your family and how we can help.

Before you begin: This application helps us understand your family's situation so we can respond with the right kind of support. Filling it out does not guarantee assistance, and it takes about 10–15 minutes. Only Section 1 (Applicant Information) is required to submit — but the more you're able to share, the better we can help.

If your family is in immediate danger, please call 911 or your local crisis line first. This form is not monitored in real time.

Section 1 of 10

Applicant Information

Please provide at least a phone number or an email so we can reach you.

Section 2 of 10

Household Information

Section 3 of 10

Current Circumstances

Check all that apply.

Section 4 of 10

Length of Assistance Needed

Section 5 of 10

Community & Church Connections

Section 6 of 10

References

Reference 1

Reference 2

Section 7 of 10

Safety Requirements

Section 8 of 10

Attachments

Online document upload isn't available yet. If you have ID, medical or disability records, an eviction notice, insurance information, or letters of reference to share, please email them to info@lionheartshouseofbread.com and reference your name so we can match them to your application.

Section 9 of 10

Unique Needs & Accommodations

Section 10 of 10

Statement of Understanding

By submitting this application, I confirm that the information provided is accurate to the best of my knowledge. I understand that completing this application does not guarantee housing, financial assistance, or any specific outcome, and that Lionheart's House of Bread will review each application individually based on available resources. I understand a member of the ministry team may contact me using the information provided above.