Financial Assistance Request Form

The Community Assistance Program is dedicated to helping individuals and families in need by providing financial support for essential needs. We understand that unexpected challenges can arise, and we aim to offer a helping hand when it is most needed. This program provides up to $500 per request to assist with various needs such as food, rent, utilities, medical expenses, and more.

Eligibility Criteria

To qualify for assistance, applicants must meet the following criteria:

Residency: Must reside in the community area (Greenville, Spartanburg, Anderson county).

Financial Need: Demonstrate financial need, as evidenced by recent pay stubs, bank statements, past due notice, or a statement of need.

Purpose of Assistance: Clearly outline the purpose of the request, such as rent, utilities, medical expenses, etc.

Documentation: Provide supporting documentation related to the request (e.g., utility bill, rent agreement, medical invoice).

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

What is your occupation / job title? *

How much is your monthly living expenses*

Less than $500Between $500 and $1,000Between $1,000 and $2,000More than $2,000

Please make a brief statement describing why financial assistance is needed. *

Which of the following do you need assistance with?*

Rent / MortgageUtilitiesVehicle ExpensesMedical

Have you requested or received assistance from another organization within the last 60 days?*

YesNo

If you answered yes to assistance, please provide name of organization.

Requested Amount*

What is the total annual household income: Check the appropriate box. *

	Under $20,000	$20,000-$30,000	$30,000-$40,000	$40,000 and Up
Income

Declaration and Signature

I declare that the information provided in this application is true and complete to the best of my knowledge. I understand that providing false or misleading information may result in the denial of assistance.

Signature*

Our team will review your application and contact you within 7 business days regarding the status of your request.

Thank you for reaching out to A Grace to Grow Community Assistance Program. We are here to support you in your time of need.

A Grace to Grow Ministry