Individual Sponsorship Request

Crossroads Need Request Form

Fill the form below (you can also contact us at outreach@crossroadschurchnj.com or 609-975-9838 if you are unable and must make other arrangements).
Your Name

First NameLast Name
Your E-mail Address (that you check)
Phone Number
Include Country Code if outside Italy
Most Recent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company (if applicable)
Name of Spouse and any/all children (with ages). Phone numbers would be helpful if you feel comfortable.
Do you have a church affiliation? If so, where?
Driver's License Number
Social Security Number (last 4 digits) XXX-XX-
(*a driver's license and/or last 4 digits of your social security number are necessary for your request to be considered. We also may ask for identification that shows your current address)
1. What is the nature of your emergency need that leads you to request assistance? (provide circumstances leading to the need for your request- e.g. fire, recent job loss, illness, injury, eviction, etc)
2. What kind of help are you specifically requesting? Please be specific- what service/dollar amount?
3. How did you happen to come to get connected with our church to seek assistance? What or who prompted you to come to us seeking help?
4. Would you please include an overall summary of your monthly expenses and income?
5. Have you received or applied to any county, state, or other private organizations for assistance? If so, please identify which ones and what assistance was given.
6. In what way(s) are you willing to contribute to your need? For example, how much money can you contribute to the need or are you willing to call for more information?
I understand that my completion of this form is not a guarantee that I will receive assitance, and that the above imformation will be reviewed by a church leadership representative(s) from this congregation.
Check One:

I have NOT received assistance from Crossroads or any other church in the 08088 zip code in the past 12 months.I HAVE received assistance from Crossroads or any other church in the 08088 zip code in the past 12 months.
Comments
By signing below, I certify that all of the above information is true and correct to the best of my knowledge. I give permission to the church board to request information from any agency to verify this information.
Signature and Date

Clear
Should be Empty:

Crossroads Need Request Form