BFC Helping Hands Hardship (Form)

BFC Believing Faithfully In Christ
BFC (Family) - Helping Hands Aid Hardship Request

"Caring For Those In Need!"
Welcome to BFC (Family) Helping Hands Ministry!

In order to better assist you, please fill-out this form and provide us with all of the necessary information we will need in order to help us determine your eligibility for approval of any funds, food, clothing, shelter, etc... Also, due to the increase of many others facing hardships, funds may or may not be available, at times, however, we will let you know.
Your Name*

First NameLast Name
E-mail*
example@example.com
*Important: Your communication with us is very important during your hardship. Our contacting you in good timing is of the essence. Please be sure to indicate a primary and a secondary phone number that we can keep in touch, if available.
Primary Contact Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
What is your date of birth?*
example: 00/00/0000
I am located in the (specify what local town or township and state) area you are staying. Type here*.
What are your current living circumstances? Explain.*
Homeless Support Services
Are you currently homeless?*

I’m staying at a shelter currentlyI have no place to goI have a voucher to currently stay at a motel/hotel temporarilyOther
How are you able to get around? Do you have transportation?

Yes, I have a car.No, I don’t have transportation.I take Public Transportation.Other
Current Photo Driver’s License# or State I.D. Photo .*

Submit current form of I.D.
Cancelof
Employment Status:*

I am currently employed.I am currently unemployed.I am on disability.I am currently laid-off.
Do you have any children?*

Yes. Ages (1-18) years old.Adult children Ages (19-24) years old.No children.
How many children do you have that are currently with you?*

I have only one child.I have two children.I have three children.I have four children.I have five children.I have six children.I have None.
Are you in need of any Food, Clothing or Shelter?*

Yes, both food and clothing.No, only food.No, only clothing.Yes, food and shelter.Yes, all of the above.
Are you currently take any medication for anxiety, depression, or other?*

I have been on medication in the past.I have not been prescribed of any medication.I take some medication.I take medication regularly.
If this applies to you, and you have taken medication in the past? Please explain.*
Homeless Support Services
Declaration of Faith: I, First Name* Last Name* do hereby acknowledge that the above information which I have provided is true to the best of my knowledge and that I have no intent to falsify or purposely mislead any of the Affiliated Network Resources including BFC (Family) Believing Faithfully In Christ Ministries that would grant me any hardship aid on my behalf, upon approval. I affix my signature
Signature* Date* . Confirm your email address indicated above: Email*
Please verify that you are human*
Should be Empty:

BFC Believing Faithfully In Christ

BFC (Family) - Helping Hands Aid Hardship Request