Benevolence Request Form

Benevolence Request Form
Date

MonthDayYear
Date
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
What is the best way to contact you?
Do you have a personal relationship with Jesus Christ?
Are you a member of Covenant Fellowship Church?
Which best describes your church attendance?
Have you requested benevolence help from Covenant Fellowship before?
Have you contacted Social Services, Faith in Action, or People Incorporated for assistance?
In your opinion, which best describes your financial situation?
What is the total amount of your request?
What will these funds be used for?
To whom should the check be made payable?
Please upload any necessary documentation.

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Are you willing to accept financial counseling?
Are you currently employed or have regular income?
What is the name of your employer?
If married, is your spouse employed?
What is the name of your spouse's employer?
What is the total number of people living at your residence and their ages;
What is your total weekly household income?
Briefly explain your needs and what led you to request assistance.
Signature

Clear
Once the completed application is submitted, it will be processed and you will be notified of the decision. Thank you!
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