Miracle Tree Emergency Assistance Application

Before You Begin

Thank you for reaching out to Miracle Tree. Our Emergency Assistance Program is designed to provide limited support to individuals and families experiencing an unexpected hardship or emergency situation.

Please note the following:

Emergency Assistance may only be requested once every three (3) months per household.
Assistance is provided based on current program resources and item availability.
Submission of an application does not guarantee assistance.
Available assistance may vary throughout the year and is subject to funding, donations, inventory, volunteer capacity, and program guidelines.
Additional information or documentation may be requested before an application can be reviewed.
Incomplete applications may delay processing.
Emergency Assistance is intended to address temporary or unexpected hardships and is not designed to provide ongoing support.

Step 1: Applicant Type

Who is submitting this request?*

I am applying for myself or my household. I am submitting an agency referral on behalf of a client.

Applicant Information

Full Name*

Date of Birth*

Phone Number*

Email Address*

Home Address*

Lagrange County IN, Steuben County IN, or Sturgis MI only.

Household Information

Number of Adults in Household*

Number of Children in Household*

Emergency Need

Please describe your emergency situation and the assistance you are requesting.*

Reason*

When did this emergency begin?*

Have you received Emergency Assistance from Miracle Tree within the last three (3) months?*

Yes No

Acknowledgment

I certify that the information provided is true and accurate to the best of my knowledge.* I understand that Emergency Assistance is limited to one request per household every three months.* I understand that submitting an application does not guarantee assistance.* I understand that assistance is based on available resources and item availability.*

Referring Agency Information

Agency Name*

Agency Contact Person*

Title/Position*

Phone Number*

Email Address*

Client Information

Client Full Name*

Client Phone Number*

Client Address*

Lagrange County IN, Steuben County IN, or Sturgis MI only.

Household Information

Number of Adults in Household*

Number of Children in Household*

Emergency Need

Please describe the client's emergency situation and the assistance being requested.*

Reason*

When did this emergency begin?*

Has the client received Emergency Assistance from Miracle Tree within the last three (3) months?*

Yes No

Acknowledgment

Uploads

ID*

Upload one ID for each adult. Photos or PDFs are fine.

Proof of address*

Type your signature*

Date Signed*

Please keep watching your email for updates after you submit.

Emergency Assistance Paused

Miracle Tree Emergency Assistance Application

Before You Begin

Step 1: Applicant Type

Applicant Information

Household Information

Emergency Need

Acknowledgment

Referring Agency Information

Client Information

Household Information

Emergency Need

Acknowledgment

Uploads