Benevolence Request Form
To begin the process of asking for support from Renaissance's Benevolence Ministry, please complete this form. After submitting the form, someone will be in contact within 48 hours. Please complete this form with as many details as possible to help us best address the need.
Your Name:
*
First Name
Last Name
Your Email:
example@example.com
Your Phone Number:
-
Area Code
Phone Number
Are you completing this form for yourself or someone else?
*
Myself
On behalf of someone else
Do you want to be involved in the process?
*
Yes
No
Other
Name:
*
First Name
Last Name
Email:
example@example.com
Phone Number:
-
Area Code
Phone Number
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marital Status:
*
Single
Engaged
Married
Divorced
Unknown
Spouse's Name:
Fiancé's Name:
Is your need directly related to the Covid-19 pandemic?
Yes
No
Describe your need for assistance:
*
What is the amount of assistance needed (in dollars)?
*
How did you arrive at this amount?
*
What other assistance have you sought or received?
*
How soon do you need this assistance?
*
In less than one week
Within the next two weeks
By the end of the month
Other
What additional needs do you have, outside of direct financial assistance?
Access to public benefits
Employment
Behavioral/Mental Health Counseling
Spiritual Counseling
Unemployment
Other
Is anyone else at Renaissance aware of your need (CG Leader, discipler, elder, member, etc.)?
*
Yes
No
Other
Please list the names of those whom we may include in discussions about your request.
Do you want to be connected to a community group?
*
Yes
No
Already attending
Which group are you a part of?
Submit
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