Benevolence Application
Name
*
First Name
Last Name
Email:
example@example.com
Phone
Please enter a valid phone number.
Date
*
-
Month
-
Day
Year
Date
Are you a covenant member at Grace Church Salado?
*
Yes
No
Marital Status
*
Please Select
Married
Single
Employment
*
Please Select
Employed Full Time
Employed Part TIme
Unemployed
Student
Select the following that best applies to your needs:
*
I have an urgent physical need (e.g. food, clothing, shelter)
I cannot pay critical bills right now (e.g. medical, mortgage/rent, insurance)
I am asking for help on behalf of someone else.
Other
Please tell us more about your situation, including the amount you need and how long you anticipate having this need?
*
Please upload any associated bills and documentation related to the help you are requesting?
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