Grace City Church

BENEVOLENCE REQUEST FORM

Benevolence eligibility will be considered for those who have completed our Growth Track and have been active participants for at least the last 6 months.

Assistance is only provided for housing, utilities, or food needs. If you do not meet the above criteria, we have names of local agencies that may be able to assist you with your need.

To proceed, please fill out the form below.

All information submitted on this form is confidential.
(* Denotes required field)

PERSONAL INFORMATION

First Name *

Last Name *

EMAIL ADDRESS *TELEPHONE NUMBER *MAILING ADDRESS *Street

City

Postal / Zip

MARITAL STATUS *Please list the names and ages of those living in your household *Have You completed our membership class? *If YES ... when?Do you serve on a team at Grace City Church? *Please list names and phone numbers for two current members of Grace City Church that you know.#1

First Name *

Last Name *

Telephone Number *#2

First Name *

Last Name *

Telephone Number ** Have you received assistance from any other church, ministry, or agency during the past 30 days?* During the past 60 days?* During the last year?EMPLOYMENT INFORMATIONPlace of employment *How long have you been employed? *Current weekly income? *If not employed, when was the the last time you had a steady job and income? *If not employed, where have you applied for work recently? *CURRENT INFORMATIONState the circumstances that have required you to request assistance today. *CURRENT MONTHLY EXPENSES* Mortgage/Rent:* Food:* Phone:* Gas/Electric* Water* Car:* Medical:* Other:* Please list your current financial needs and amounts.Please provide two family references.#1

First Name *

Last Name *

* Phone Number:* Relation#2

First Name *

Last Name *

Phone Number *Relation *

Thank you!
Our Home Team leaders will review your request and respond shortly.

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