Request for Disaster Relief
Disaster Management Team, Texas Ministries of the Church of God
This is a financial needs assessment document
used by the Texas Ministries of the Church of God (Anderson IN) Disaster Management Team (DMT) to assess the needs of the congregation following a disaster. It is our desire "to restore every impacted congregation to 100% of its pre-disaster ministry capacity, to the extent possible." In this assessment you will be be asked to detail the damage incurred, your immediate needs, and relief expectations. So as to fully understand your congregation's financial picture you will be asked to submit scanned documentation of your profit & loss statement, balance sheet (assets & liabilities), bank and investment statements, and proof of insurance. Please have these documents scanned as PDF files, ready for upload as you complete (and finally submit) this request form.
Is Your Church (or Organization) a Texas Ministries Partner?
Please Select
Yes
No
Name of Your Church (or Organization)
Name
What is Your Church's (or Organization's) Mailing Address?
Address
Address Line 2
City
State / Province
Postal / Zip Code
Contact Person
*
First Name
Last Name
Email of the Contact Person
*
example@example.com
Phone number of Contact Person
Phone Number
Mailing Address of the Contact Person
*
Mailing Address
Mailing Address Line 2
City
State / Province
Postal / Zip Code
What is the contact person's position with this church or organization?
Contact Person's Position
Provide a short description of the type of disaster that occurred.
When did the disaster occur?
-
Month
-
Day
Year
MM-DD-YYYY
What is your immediate need or concern?
Detail your needs.
What are you expecting from the State Disaster Team?
Detail your expectations.
What is the estimate of cost of damages?
Damage estimate
Financial Assessment:
Please provide a complete financial picture of your church's profit & loss, operating expense, assets/liabilities, and insurance. You will be asked to attached scanned documents. Please have those documents ready for upload as you complete this form.
Upload your church or organization's profit & loss statement
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Attach latest P&L statement
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of
Upload your assets and liabilities statement
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Attach your organization's assets & liabilities statement
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Upload your church's or organization's recent monthly checking statements
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Attach checking account statement
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Upload your church's or organization's recent monthly savings statements
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Attach savings account statement
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Upload your church's or organization's investment account statements
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Attach investment account statement
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Upload your church's or organization's other banking or investment statements
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Attach any bank or investment account not included in the above submissions.
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of
What is the name of your insurance company?
Name of Insurance
What does your insurance cover?
Briefly describe your insurance coverage
How much is your deductible?
Upload proof of insurance
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Attach a copy of proof of insurance
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of
The information provided in this application shall not be shared to anyone else and is kept confidential
I agree that the information herein is true and correct
Yes
Submit
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