Assistance Request Form

Assistance Request Form
Your Name

First NameLast Name
Your E-mail Address
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Connection to Gathering Church

I am a memberI have attendedOther
What assistance are you in need of?
If monetary, how much are you requesting?
What is your timeline for the need?
Where else have you sought out assistance?
If you are requesting assistance with rent, mortgage, or a bill please leave us all necessary information below (ph # to contact agency, mailing address, acct #, etc.)
All needs must be presented to representatives of the elder team for approval. Requests may or may not be granted and the way in which they are met is at the discretion of the elder team. For updates please email June.Johnson@ComeGather.com

Thank you
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