Gasoline Assistance : Transportation : Get Help : Friends In Sonoma Helping (FISH)

Apply for Gasoline Assistance

FISH provides transportation to medical appointments which includes private car rides by FISH volunteers, bus tickets, or gasoline. For rides or bus tickets, please call FISH at 707-996-0111.

The gasoline assistance program serves residents of Sonoma Valley. To apply for gasoline for your medical appointment, complete the following form and a FISH volunteer will contact you within two business days. Please be sure to answer your phone or immediately return the voicemail message. If you need help with the application, please call 707-996-0111.

If you are homeless or a client of HAS or The Haven, please contact SOS at 707-939-6777 to apply for gasoline.

Gasoline Assistance Application

Name

First Name *

Last Name *

Home Address (no P.O. Box)

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Phone

cxrvapq4vq4m

Date of Birth

Month

Day

Year

Vehicle License Number

Are you requesting gas assistance for:

Single Medical Appointment
Ongoing Medical Appointments
Other reason

Medical Appointment Date(s) and Time(s)

Medical Provider Address and City

Country

Address Line 1

City

State/Province

Postal Code

Medical Provider Phone Number

ext Extension

If not for a medical appointment, what is the reason for this gasoline request?

This form completed by (name):

Please note: FISH can only consider applications from those who live within Sonoma Valley (from Schellville to Kenwood). For additional resources providing financial assistance, visit 211Sonoma.org.

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