Client Signup

Completing a Request for Assistance

We depend on the caseworkers, social workers, and other medical or social employees to assist the patient in preparing the request for assistance. Please be sure to obtain a signature for the release of information at the end of the request and include a referral form.

We also need information on letterhead from the doctor,  clinic, or hospital that is caring for the patient that provides an indication of the medical condition of the person. We do not need nor want several pages of information, just something that shows what the issue is.

We need a copy of the bill to pay against as funds go to directly to the vendor. This can be a copy of a lease if the request is for rental assistance, or a CPS bill. It can be a copy of a billing from the hospital if it is for a co-payment.

If the need is for clothes due to loss of weight or a wig, send something that indicates how and why this occurred, such as chemo treatment or wasting illness.

If the need of clothes for children is due to parents’ inability to provide, please send an explanation. We can also provide a holiday basket if needed.

We must have a copy of a picture ID and a social security card. If these have been lost for some reason, we can accept other identifying items such as a Medicare or Medicaid card.

If the request form is too extensive for the amount requested, please complete only what is needed to provide the information.

Click Here to download application.

Mail completed requests to:

We Are Alive
2400 McCullough Ave #12273
San Antonio, Texas 78212