Relief Fund Purpose Statement

This relief fund is resourced by the love and generosity of our Christian family. The fund provdes assistance for those directly affected by the COVID-19 pandemic by providing grocery cards to those who qualify. The goal is to help as many people in need as possible beginning with those in the greatest need. Many factors affect our ability to grant assistance and all may not quaify. Subjet to funds availability. THIS FORM HAS BEEN UPDATED, PLEASE READ CARFULLY.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Are you a member of The Rock? (verifiable by our church records which means you filled out a Welcome Card or gave an offering at least once)*

YesNo

How many adults (18 years old and older) currently live in your home?*

How many children (0-17 years old) currently live in your home?*

Are you or an adult in your household employed?*

YesNo

Has this adult's hours been reduced due to the Coronavirus restrictions?*

YesNo

Have you researched local / county / state assistance? (Many programs are available during this crisis.)*

YesNo

This relief fund is to help provide grocery cards affected by the Coronavirus situation. Tell us your story. Be as specific as you can.*