• Address: 206 Agnes Dr., Eatonton, GA 31024
  • Service Area: Middle Georgia, Rural Georgia, and the Nearby Metro Areas.

R2T Assistance Application

1. Personal Information

Full Name:
Address:
Date of Birth:

2. Household Information

Selected Value: 0

3. Financial Information

Source(s) of income (e.g., employment, government assistance):

Please note that all financial information you provide through this form will be kept strictly confidential and used solely for the purpose of evaluating your application. We are committed to protecting your privacy and will not share your information with any third parties without your consent.

4. Assistance Requested

Type of assistance needed (e.g., electricity, water, rent):
Due Date of the Bill:

5. Reason for Request

6. Documentation Required

Click or drag files to this area to upload. You can upload up to 10 files.
"Please attach the following documents: • Copy of the bill needing assistance • Proof of income (e.g., pay stubs, benefit statements) • Any other relevant documents (e.g., eviction notice, medical bills)"

7. Family Support

Have you contacted family members for assistance?

8. Other Support

Have you sought assistance from any other organizations or resources?

9. Acknowledgment and Consent

Checkboxes

10. Other resources that may be able to assist:

"Other resources that may be able to assist:
• Putnam County Christian Outreach"

Clear Signature
Date / Time

Instructions for Submission:

Upon completing this form, your application will be automatically sent to Reach2Teach, Inc. at Reach2Teach03@gmail.com.
Please allow 2 to 3 business days for the review of your application after submission.
Assistance is subject to the availability of funds.