Afaha Akpan Foundation

Full Name*

Email*

Phone*

Date of Birth

Address*

Nationality*

Gender*

MaleFemale

What type of welfare support are you seeking? (Check all that apply)

Food aidClothingMedical assistanceHousing supportEducational supportFuneral cost supportOther

If Other (Specify)

How much support do you need? (Please specify the amount in local currency)

Please explain the situation that has led to your need for welfare support:(Please provide a brief explanation)

Have you received any other form of welfare support in the past?*

YesNo

If yes, please provide details

Are you currently employed?*

YesNo

If yes, please provide your occupation and employer details

Occupation

Employer

If not employed, what is your current source of income (if any)?

Do you have dependents (children, elderly, or other family members in need of support)?

Relationship

Are there any urgent medical or other needs you would like the Foundation to be aware of?

YesNo

If yes, please provide details

References

Please provide two references who can speak to your character or potential for growth:

Relationship*

Email Address*

Phone*

Relationship*

Email Address*

Phone*

Parental Consent (For Applicants Under 18)

I, the undersigned, am the parent/legal guardian of the applicant and hereby give my consent for the Afaha Akpan Foundation to consider my child/ward’s application for welfare support.

Parent/Guardian Full Name

Relationship to Applicant

Parent/Guardian Email Address

Parent/Guardian Phone

I agree that the Afaha Akpan Foundation may contact me for further verification or additional information as needed.

YesNo

Consent : I hereby consent to the Afaha Akpan Foundation using the information provided in this application to assess my suitability for welfare support.

YesNo

Signature of Applicant (if over 18) / Signature of Parent/Guardian (if under 18)

Disclaimer:
All costs associated with providing welfare support will be paid directly to the provider or institution. The Afaha Akpan Foundation does not disburse welfare funds directly to applicants or their families.

Welfare Support Application Form

Personal Information

Full Name*

Email*

Phone*

Date of Birth

Address*

Nationality*

Gender*

Welfare Needs

What type of welfare support are you seeking? (Check all that apply)

If Other (Specify)

How much support do you need? (Please specify the amount in local currency)

Please explain the situation that has led to your need for welfare support:(Please provide a brief explanation)

Have you received any other form of welfare support in the past?*

If yes, please provide details

Are you currently employed?*

If yes, please provide your occupation and employer details

Occupation

Employer

If not employed, what is your current source of income (if any)?

Family Information (If Applicable)

Do you have dependents (children, elderly, or other family members in need of support)?

If yes, please provide details

Name

Relationship

Age

Needs

Name

Relationship

Age

Needs

Name

Relationship

Age

Needs

Are there any urgent medical or other needs you would like the Foundation to be aware of?

If yes, please provide details

References

Name*

Relationship*

Email Address*

Phone*

Name*

Relationship*

Email Address*

Phone*

Parental Consent (For Applicants Under 18)

Parent/Guardian Full Name

Relationship to Applicant

Parent/Guardian Email Address

Parent/Guardian Phone

Signature

Signature of Applicant (if over 18) / Signature of Parent/Guardian (if under 18)

Date

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