Driving Hope Inc is located in Alabama and serves Central Alabama Please enable JavaScript in your browser to complete this form.Checking the box below indicates you have read this paragraph. *The heart of this ministry is to financially help those who are truly in dire need. Driving Hope Inc may help with a minor expense for or repairs to a client owned vehicle for a client who is legally able to operate a vehicle in Alabama (valid drivers license (DL), tag and insurance). DHI may also help with DL, tag and insurance expenses if needed. Minor expense examples are expenses such as a tire or battery, etc. Minor repair examples are repairs such as a replacing a starter or alternator, etc. All applications will be considered on a case by case basis. Driving Hope Inc. serves Central Alabama.Name *FirstLastAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Select all that apply *I need financial aid with minor expenses or repairs for personal vehicle (i.e. battery or tire or alternator)I need help securing a DLI need help with tag and insurance expensesStatus of Drivers License? A copy of license is required for vehicle repairs and expenses. *SelectValidSuspendedNever had a DLStatus of tag and insurance? A copy of the tag receipt and insurance card is required for vehicle repairs and expenses. (Enter NA if applying for DL help only) *SelectOnly Tag is currentOnly Insurance is currentBoth Tag and Insurance are currentI need help with Tag and/or Insurance expensesNAYear, Make and Model of vehicle. (Enter "NA" if applying for DL help only) *Status of Title? A copy of the title or loan documentation will be required. (Enter "NA" if applying for DL help only) *SelectI have title in hand. Vehicle is financedTitle is pawnedVehicle belongs to someone elseNADescribe minor expenses or repairs needed. (Enter "NA" if vehicle repair/expense is not requested) *I acknowledge that copies of license, insurance card and proof of title will be required for vehicle repairs or expenses *AcknowledgedWhy would you qualify for financial aid? *Select Age Bracket *Select16 - 1819 - 2526 - 3940 - 5555 and olderHousehold membersSelect1 Adult2 Adults1 Adult plus children2 Adults plus childrenMore than 2 AdultsMore than 2 Adults plus childrenSelect Household Income Status *SelectSingle Income householdDual Income householdSelect Household Income Type (Select all that apply) *SelectEmployedDisability or Social Security onlyRetirement Income and Social SecurityNone of the aboveHow much money can you pay toward the cost of your need? *How did you hear about Driving Hope Inc? Please give name of person or organization *I would like to receive the monthly e-newsletter "The Spark Plug. *YesNoExpect a phone call from Rick with Driving Hope from 205-259-8208 to discuss details of application. *AcknowledgedConfirmation *I confirm that all answers are correct and I understand that submission of this form does not guarantee assistance. NameSubmit