Veteran Aide Vincent P. Gurucharri, MD Foundation Harrisburg Christian Church Financial Help Application Name(Required) First Last Address(Required) Street Address Address Line 2 City State 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 ZIP Code Contact Phone Number:(Required)Contact Email:(Required) Have you had a recent loss of income or unexpected expenses? Explain:(Required)What other financial assistance have you sought or applied for? Explain:(Required)Are you a member of a local church?(Required) What are some specific needs or bills that we can help with? Please be specific.(Required)NameThis field is for validation purposes and should be left unchanged. Δ