M
inistry of Kindness/Poor Stewards Application
Name
Date
/
Month
/
Day
Year
Date
Address
Phone Number (Home)
Phone Number (Cell)
Please enter a valid phone number.
Email
example@example.com
What is the assistance for?
What circumstances created your need?
Are you a member of Memorial AME Zion church?
Yes
No
How long do you expect to need assistance?
How much assistance are you requesting?
Who should the Church make the check(s) payable to?
Are you currently employed?
If married, is your spouse employed?
Total number of people in your household?
Total monthly household income?
If applicable, are you willing to receive financial counseling?
Signature
If married, signature of spouse
M
inistry of Kindness Committee Use Only
Committee Chairperson Signature
Approved
Modified
Denied
Denied
Date
Date
/
Month
/
Day
Year
Date
Check Written to
Check No.
Check Date
/
Month
/
Day
Year
Date
Preview PDF
Submit
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