Form
Thank you for reaching out to Heartland Church. For best results please give complete information so we can respond promptly.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Best Way to Contact You?
*
Please Select
Phone Call
Email
Text
What is Your Need?
*
Please Select
Financial Assistance/Benevolence
Funeral
Prayer
Pastoral Counseling
Wedding Planning
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Wedding Planning
Congratulations! We look forward to helping you with this special event.
Wedding Date
*
-
Month
-
Day
Year
Date
Venue Name/Address (If Decided)
Pastoral Officiation Needed?
*
Yes
No
Premarital Counseling Requested?
*
Yes
No
Estimated Number of Guests
*
Any Special Request?
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Funeral
We are so sorry for your loss. Our team will reach out to you soon.
Is your family a member of Heartland?
*
What funeral home are you using?
*
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Pastoral Counseling
At Heartland Church, we believe in asking for help and counseling is a great way to ask for specific help when you need it. Our care team is ready to respond to your needs. *Please know that this online request process is not set up to handle emergencies. If you are having a medical emergency, or having thoughts of self-harm or suicide it's important that you seek immediate medical help, crisis intervention or suicide prevention services. For immediate assistance, please dial 911 or go to your local emergency room.
Type of Counseling?
*
Please Select
Family
Individual
Marriage/Couples
Premarital
Other
What type of counseling are you requestings?
*
Urgency Level?
Please Select
Immediate
Soon
No Rush
Brief description of crisis/situation?
*
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Financial Assistance/Benevolence
Our benevolence team works closely with everyone who attends Heartland regularly and requests financial assistance. Our goal is to help you overcome the current crisis and make financial decisions so you will not need assistance again.
Do you attend Heartland Church in person?
*
Yes
No
Type of Assistance Needed?
*
Please Select
Rent
Utility Bill
Groceries
Other
What type of Financial Assistance/Benevolence are you requesting?
*
Urgency Level?
Please Select
Immediate
Soon
No Rush
Has the Church assisted you before?
*
Yes
No
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Prayer Request
Your prayer requests and praise reports are important as we walk with you. Please follow the instructions below.
Click below to receive prayer from our team!
Prayer Request
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