Households Needs Request

The Potter's Hands

Please read the instructions carefully and completely before doing the application. 

Note: Only Case Managers or Church Representatives are to submit this application.


Each applicant needs to be referred to Potter's Hands by an agency or local church representative. The caseworker/church representative must submit the initial application by email and also accompany the client to the appointment. Please submit the "Household Needs Request" form to send a message before an appointment can be scheduled.


Please include a detailed list of items needed on the form. Caseworker/church leader needs to confirm items requested. 


  • Please specify if items can be picked up or need to be delivered. Pick-up within 15 days of appointment is preferred and greatly appreciated. If delivery is needed, please include any special instructions as necessary (floor number, front, side, or rear entrance, etc.).
  • If a stove is needed, please specify gas or electric.
  • If beds are needed, please specify quantity and size (queen or twin only). By availability. 


Clients can only apply to Potter's Hands once every 12 months. 

*Although we want to complete every request, we do not have the ability to do so. Given this, The Potter's Hands maintains the right to use discretion regarding priority of requests on a case by case basis. 

The following is to be completed by our office.