Benevolence Fund Request Form

Benevolence Fund Request Form
Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you regularly attend What's New Worship?*

YesNo
Are you widowed of any age or an orphan and under the age of 21?*

YesNo
How many people live in the home and what are their ages?*
List a place of employment for all adults living in the home and how long each has been employed. If unemployed, please explain why.*
From what other sources have you tried to get assistance?*
Please list your recent hardship and how this need came about.*
What is the need? (Please be specific. Provide the dollar amount needed, who to make the payment to, account number, and a copy of the bill/rental agreement if possible below).*
A form of ID must be submitted to verify the request. Please answer all questions thoroughly. The request will automatically be denied if the form is not completed in its entirety and supporting documentation is not submitted. Be advised, the committee prayerfully considers every request, but not all requests are approved due to the amount of requests received and the limited resources available. The committee may take up to two weeks to make a decision. The committee will not approve any requests needed in less than 24 hours unless the need was unforeseen.
Please upload a copy of your photo ID and copy of necessary bills needing help with.*

Cancelof
Total amount requested ($):*
Date*

MonthDayYear
Date
Should be Empty: