Application for Assistance

WE DO NOT OFFER ASSISTANCE FOR RENT, HOTEL STAYS, OR MORTGAGE PAYMENTS.

Thank you for taking the time to fill out this form. Please be thorough, and do not leave any questions blank.

REQUIREMENTS FOR ASSISTANCE:
While we want to assist people in need, we have limited resources available. Because of this, we can only help those who meet the following criteria:
1. Must be a resident of CITRUS COUNTY.
2. Must be willing to come to the SRC Church Office.
3. Click on this link to watch a short video about care at Seven Rivers Church.

After you submit this form, someone from Seven Rivers Church will be in contact with you within 48 business hours. Please contact the church office if you have any questions (352-746-6200).

NAME*

First NameLast Name

EMAIL*

example@example.com

PHONE NUMBER*

Please enter a valid phone number.

ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code

AGE*

DATE OF BIRTH*

MonthDayYear

GENDER*

MALEFEMALE

SPOUSE/SIGNIFICANT OTHER'S FULL NAME (if applicable)*

NUMBER AND AGES OF CHILDREN*

DESCRIBE YOUR NEED FOR ASSISTANCE (INCLUDE $ AMOUNT)*

WHAT EVENTS LED TO YOU NEEDING ASSISTANCE?*

HOW DID YOU HEAR ABOUT SEVEN RIVERS CHURCH?*

HAVE YOU EVER RECEIVED ASSISTANCE FROM SEVEN RIVERS CHURCH?*

YESNO

ARE YOU A MEMBER OR REGULAR ATTENDEE OF CHURCH?*

YESNO

IF YES, NAME OF CHURCH AND PASTOR*

ARE CURRENTLY EMPLOYED?*

YESNO

IF YES, WHERE AND FOR HOW LONG?*

ARE YOU ABLE TO CONTRIBUTE YOUR OWN RESOURCES TO MEET THIS NEED?*

YESNO

DO YOU HAVE ANY FAMILY OR FRIENDS WHO ARE ABLE TO CONTRIBUTE TOWARDS MEETING THIS NEED?

YESNO

WHAT STEPS HAVE YOU TAKEN SO FAR TO TRY AND MEET THIS NEED?

LIST ALL CHURCHES OR AGENCIES CURRENTLY PROVIDING ASSISTANCE, OR FROM WHICH YOU HAVE REQUESTED ASSISTANCE FROM WITHIN THE PAST YEAR.

DESCRIBE AID RECEIVED

Please click on this link to watch a short video, and answer the questions below:

Are there any parts of Joy's story that feel similar to your own? Why or why not?

Thank you! A member of our staff will contact you within two business days.