Emergency Assistance

Families can receive up to 100 diapers, wipes, and other baby essentials based on the circumstances of their case.

Requirements

Ensure You're Eligible For Aid

This form should only be completed by Community Partners, Organizations, or Social Service Agencies referring a client(s) for emergency diaper assistance.

The family needing Emergency Assistance should meet at least one of the following:

Recent homelessness
Recent domestic violence
Disability of the mother or child
Kinship Foster Care
Be a crisis case based on the information provided by the referring agency

The prospective client must also:

Be on WIC or SNAP and be able to present an active card
Have a valid photo ID

Donation pickup is at our office location: 2711 S Ervay #102, Dallas, Texas 75215 – unless otherwise coordinated with the pantry.

"*" indicates required fields

Who is in need of the emergency assistance?

Parent or Guardian Information

Full Name*

Date of Birth*

Email Address*

Phone Number*

Name of organization parent or guardian is currently receiving assistance from as a referring agency:*

Referrer Information

Your Name*

Your Organization

Your Email Address*

Your Phone Number*

Client Information

Client Name*

Client Date of Birth*

Client Email Address*

Client Phone Number*

Client Address of Residence (including zip code)*

Is the potential client currently receiving services from the referring program or organization?*

Yes

Please check the requirement for Emergency Assistance met by the potential client:*

Please describe the potential client's crisis leading up to Emergency Assistance being requested.*

Child Information

Child Name*

Child Date of Birth*

Diaper Size for Child Receiving Diapers*

Confirmation

By entering your first and last name below, you certify that the information provided in this referral is accurate. You also approve for ilooklikeLOVE to contact the potential client and referring agency contact via email or by phone to verify the information provided or to get additional information.

Phone

This field is for validation purposes and should be left unchanged.