KUMC Financial Assistance Application
Please provide answers to the following questions and someone will contact you within 5 business days to discuss how Kirkwood United Methodist can provide assistance. Email mission@kirkwoodumc.org with any questions. Thank 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.
Amount of financial assistance requested
Reason for the request
Rent
Utilities
Car Repair
Other
Please upload a copy of the bill/invoice for which you are requesting assistance.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
What is the total average gross income per year for your household? Include gross wages, tips, Social Security, disability, pensions, annuities, alimony, child support, unemployment, public aid, or self-employment.
How many dependent children reside in your home?
Have you contacted or received assistance from any other helping agencies in the past 12 months?
Yes
No
Which helping agencies have you contacted?
Kirkcare
St Vincent de Paul
Community Action Agency of St Louis County (CAASTL)
No applicable
Other
Have you participated in financial education or individual coaching in the past?
Yes
No
Are you interested in participating in three FREE individual financial coaching sessions with a Certified Financial Social Worker with the opportunity to receive up to $100 to be depositied into a personal emergency savings account?
Yes
No
Maybe
Please use this space to share any other relevant information
Submit
Should be Empty: