Application for Assistance (Community)
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
Male
Female
Number of children and ages
Please describe your specific request:
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What event(s) lead to you needing assistance?
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Do you live within a three-mile radius of TCPC?
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Yes
No
How did you learn about / get connected to TCPC?
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From whom have you received assistance in the last six months?
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Family or friends
Other church(es)
Local agencies
None of the above
Do you currently attend church?
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Yes, regularly
Yes, occasionally
No
If regularly, where do you attend?
*
Are you currently employed?
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Yes, full-time
Yes, part-time
Yes, hourly
No, I'm currently unemployed
Where are you currently employed?
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Are you willing to meet with someone on a Sunday morning to discuss this?
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Yes
No
Are you able to contribute some of your own resources to help meet this need?
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Yes
No
How can we come alongside you and support you?
I want to learn or improve my English.
I am looking for an after-school activity/tutoring for my child/children.
I am suffering the loss of a loved one or friend.
I am struggling financially and need help budgeting.
I have an urgent need for financial assistance.
I have an urgent need for food assistance.
I am struggling in my marriage and/or parenting.
I would like someone to talk to.
I need healing from sexual abuse
I feel stuck in life.
Are you interested in knowing more about the following?
TCPC and our worship service
Relationship with God
Understanding the Bible
Talk with a pastor
By signing below, I authorize Tates Creek Presbyterian Church to verify any information provided above with other churches or agencies in order to help meet my needs.
*
Submit
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