Family/Friend Application on Behalf of Widow
Your Information
A bit about you...
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your relation to the widow:
Widow's Information
The widow you are representing...
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How long has this woman been a widow?
Is this widow a conservative Anabaptist Christian?
In a few short sentences, tell us a bit about this widow's story from your perspective. (Include how she became a widow and some of her journey from then to now.)
How would you desribe this widow's financial state?
In Need
Making it Work
Adequately Taken Care Of
To your knowledge, does this widow receive any monthly financial aid?
If this widow is receiving financial aid, from whom is it coming? (select all that apply)
The Church
Family
Friends
Other
N/A
How would you desribe the involvement/emotional support of this widow's church leaders & fellow church members?
None are involved and supportive
The church leaders are involved and supportive
The church members are involved and supportive
Both the church leaders and the church members are involved and supportive
Other Info:
Widow's Date of Birth
Date of Wedding Anniversary
Date of Husband's Passing
Does this widow have any children living at home? If she does, please list children's names & ages.
Referral For Second Application
Please give us the info for this widow's pastor or advisor so we can send an application to a second party. This can be any person who knows the widow's situation well and is supportive of her.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: