PASTORAL CARE
How can we best serve you today? (Please select an option below.)
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Prayer – I’d like someone to pray with/for me.
Visitation – I’d like a visit from a Pastor or Life Care team member.
Financial Assistance – I need financial assistance
Counseling – I’d like to speak with a Pastor.
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Personal Information
Name
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First Name
Last Name
Email:
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Contact Number:
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Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Life Church location you attend
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Allentown
Bethlehem
Center Valley
Easton
Macungie
Nazareth
Reading
I am part of the following Small Group(s):
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Request For Prayer
Please provide a brief description of your prayer need:
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If you’d like a specific pastor to contact you, please enter their name below:
Request For Visitation
I’d like a visit from a Pastor or Life Care team member.
Briefly describe your situation:
Request For Financial Assistance
Brief description of your current needs: Including specific type of assistance need and the amount.
Household Information
Your Full Name (including Middle name if you have one):
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First Name
Middle Name
Last Name
Full name of Spouse (if applicable):
First Name
Middle Name
Last Name
Number of Children in the home?
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Number of adults in the home?
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Is anyone in the home a veteran?
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YES
NO
Employment Information:
Employer's Name
Employer's phone #:
Format: (000) 000-0000.
Employer's address:
Street Address
City
State / Province
Postal / Zip Code
Have you exhausted all other avenues in trying to resolve the issues?
YES
NO
Have you trimmed your budget by removing extra expenses such as, cable TV, cell phone data plan, etc...?
YES
NO
Are you actively seeking employment or a promotion and/or helping spouse and adult children to find employment?
YES
NO
Have you contacted community service agencies for help such as, Unemployment Benefits, Salvation Army, Food Banks, Pathways?
YES
NO
Is this need an EMERGENCY that must be taken care of now?
YES
NO
A Copy of your valid photo ID is required for processing. Upload any documentation showing proof of financial need ie: lease, bill, eviction notice, etc. — (Be sure to click BEGIN UPLOAD after you drag your file into the space below.)
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Have you previously received financial assistance from us before?
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YES
NO
When?
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Request For Counseling
Note: At times, we may refer you to a licensed Christian counselor who aligns with our values and meets our referral standards for the best care possible. Life can present overwhelming challenges, difficult decisions, and moments where guidance is needed. That’s why the Church exists—to walk alongside you and help you navigate life according to God’s principles.
Reason for Pastoral Counseling:
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