Ukrainian Assistance Form

First Name *

Last Name *

AGC Church Name

City *

Province *

If you are in a province that is not listed here, we encourage you to register with provincial organizations that are helping Ukrainians.

How Can You Help?

I can help with HOUSING. *

Yes

No

Rent Free? *

Yes

No

Rental Amount Required? *

Number of Bedrooms

Other Spaces Available

Shared Bathroom

Shared Kitchen

Shared Living Space

Private Bathroom

Private Kitchen

Private Living Space

Do you own pets? *

Yes

No

What types of pets do you have? *

Number of Adults

Number of Children

Preferred Childhood Stage(s)

Babies/Toddlers

Primary School

High School

How long could you host a family for?

How many people currently live in your home?

What is your current family configuration? i.e. 2 adults and 3 school aged children; or 1 adult, 1 senior and a toddler, etc.

I can help with FINANCES. *

Yes

No

(Airplane Tickets, Start-up cash, Groceries, etc.)

Amount? *

I can help with EMPLOYMENT. *

Yes

No

Job Description and Details *

I have HOUSEHOLD ITEMS to donate. *

Yes

No

List of Items *

I can help with CROSS-CULTURAL sensitivities. *

Yes

No

Ideas to Help *

Other Comments / Questions *