Financial Assistance Request Form

Need Assistance?

Please note that NBMOC is not a government-assisted organization. The resources originate from the donations of local church congregants and other individuals. We only service families that live in Nash or Edgecombe county and you may only receive assistance once every 12 months.

Applicant Information


Family Household




Monthly Earnings

Please include your total monthly household income (Employment, Child Support, Social Security, Disability, ETC). Enter numeric values only.

Expenses

Enter numeric values only.

Submit