Benevolence Request

Benevolence Request
Benevolence eligibility will be considered for single parents with children under the age of 18 living at home or widows who have completed Next Steps and have been consistently serving at least 6 months. Benevolence requests are for financial assistance for past due rent or utilities. If you do not meet the above criteria, we have names of local agencies that may be able to assist you with your need. Please reach out to careteam@gutschurch.com for any questions or a list of agencies. All information submitted on this form is confidential.
Full Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Area CodePhone Number
E-mail Address:
Marital Status:*
Please list the names and ages of those living in your household:*
Have you completed our membership class?*
If so, when?*
What areas do you volunteer in and for how long?*
Services you regularly attend:*

Sunday 9:30amSunday 11amSunday 6pmWednesday 7pm
What campus do you attend?

TulsaSkiatookSapulpaEspanol
Please list two names and phone numbers for at least two current members of Guts Church that you know.
Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
Have you received assistance from any church, ministry, or agency during the past 30 days?*
During the past 60 days?*
During the past year?*
Employment Information
Place of Employment:*
How long have you been employed?*
Current weekly income?*
If not employed, when was the last time you had a steady job and income?*
If not employed, where have you applied for work recently?*
Current Information
Briefly state the circumstances that have required you to request assistance today.*
List your current monthly expenses:
Mortgage/Rent:*
Food:*
Phone:*
Gas/Electric:*
Water:*
Car:*
Medical:*
List any others:
Please list you current financial needs and amount:*
Do you have relatives or friends who are capable of assisting you with food/housing?*
Family References
Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
Relation:*
Occupation:*
Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
Relation:*
Occupation:*
Company Information
If you are requesting a bill payment, please supply the following information along with a copy of the bill(s). You can fax the bill (s) to 918-627-8596 or email careteam@gutschurch.com.
Company Name:
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Account Number:
Total Amount Due:
Amount Required:
Company Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Account Number:
Total Amount Due:
Amount Required:
Should be Empty:

Benevolence Request

Employment Information

Current Information

Family References

Company Information