Applications

Welcome To The Application Page

If you are interested in our services from the Leona Project all you have to do to get started is to fill out the Application below. If we are low on funds we inform you of that and your application will be placed on our waiting list in our Data Base. We are on a first come first serve basis. This program helps in so many ways. We not only help raise money for you but if you have already started something of your own we will help you in your own endeavors. We hope that the application process isn't difficult. We tried to make it as smooth as possible, but there are some mandatory questions that needs to be answered in order to weed out the people that really don't have cancer and are trying to take advantage of our system. To get started just fill out the application and hit submit. We look forward to working with you.

Application For Services

Personal Information

* Indicates required field

Date *

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Marital Status *

Married Single Separated Divorced

Employment Information

Are You Currently Employed ( If yes click the ? for instructions) *

Yes No

Note: If your answer is yes please upload the appropriate documents.

Upload File *

Max file size: 20MB

Do You Receive Unemployment Checks *

Yes No

Note: If you do receive Unemployment please fill out the next several fields below. If you don't you may skip and go to the next section.

How Much Do You Receive in Unemployment *

Please choose one *

Weekly Bi-Weekly Monthly Other

If other please fill out *

Services

If other please fill out *

Please upload your most recent cancer bill *

Max file size: 20MB

Verification Check (Medical and Employment Verification)

Please Initial *

Social Security Number *

Date Of Birth *

Check List

PLEASE PROVIDE THE FOLLOWING THINGS ALONG WITH YOUR APPLICATION:

A COPY OF STATE ISSUED PHOTO ID

EMPLOYMENT INFORMATION (ACCEPTABLE FORMS BELOW)
* 2 MOST RECENT PAY STUBS ( IF APPLICABLE)
               * W-2 FORM
               * 2 MOST RECENT UNEMPLOYMENT STUBS (IF APPLICABLE)
               * NOTARIZED LETTER STATING THAT YOU ARE NOT EMPLOYED ( IF
                   APPLICABLE)

COPY OF YOUR MOST RECENT MEDICAL BILL

Remember if you cannot upload your needed information you can always mail it to us at the Address below, but please fill out the application before sending us the information. We are trying to make this as seamless as possible but sometimes things can't be and we understand
PLEASE SEND ALL OF THE REQUESTED INFORMATION TO THE ADDRESS BELOW:

ALPHA WORLD ENTERTAINMENT INC.
ATTN: PAULA BROWN
504 S MARLYN AVE. SUITE 1A
ESSEX, MD. 21221

WE LOOK FORWARD TO WORKING WITH YOU!!!!!!!!!

Comment *

Submit