Intake Form

  • Welcome to the Clergy Assurance Fund Benefits and Grants Form.

  • Use this form to update your policy information, enroll, designate a beneficiary, or apply for one of our grants.

    Most people finish in about 5–10 minutes.

    If you have your Policy Number handy, please have it ready. While not required, it helps us speed up the location of your policy.  

    Some questions will require supporting documents which will help in determining our ability to help. Please upload those when required.

    All amounts are subject to annual limits per fiscal year.

  • About You

  • Who is completing this form today?*

  • Clergy or Members


  •
  •  - -
  • What is your date of birth?*
     / /
  • What can we help you with today?*

  • Clergy Spouse or Family


  •
  •  - -
  • What can we help you with today?*

  • Neither Member nor Family

  • We understand that not every family fits into neatly defined categories, and we are dedicated to helping clergy and their families with any situations that may arise. Please email us at operations@clergyassurancefund.org or call us at (215) 557-6960 so that we can determine how best to serve you. We are committed to responding with the utmost care.

    If this is a spiritual matter and you'd prefer to speak with the Chaplain, please email at chaplain@clergyassurancefund.org or call (215) 557-6960 and we'll reach out to you as soon as possible.

    Thank you and God bless.

  • Options Not Listed

  • If you need help with something that's not listed in these options, please email us at operations@clergyassurancefund.org or call us at (215) 557-6960 so that we can asses how best to serve you. We are commited to serving clergy and their families witht he utmost care. 

  • Manage my Policy

  • How would you like to manage your policy?*

  • Update my Information

  • What information needs updating?
    • New Mailing Address 
    • New Email 
    • New Phone Number 
    •  - -

  • Beneficiary Designation

  • Purchase Additional Coverage

    All requests are subject to review and adjustment.

  • Insurance Limits:

    To age 40: $150,000

    Age 41-50: $100,000

    Age 51-60: $75,000

    Age 61-72: $50,000

  • How would you prefer to pay your premiums?*

  • Apply for a Member Grant

    Grants are subject to annual limits.
  • Grant Type
    • Wellness Grant 
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Spiritual Renewal Grant 
    • When does the experience start?
       - -
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Sabbatical Grant 
    • When is the first day of your sabbatical?
       - -
    • When is the last day of your sabbatical?
       - -
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Spousal Death Benefit 
    • What was the date of death?
       - -
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof

  • Submit a Claim

  • What was the date of death?*
     / /
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Apply for a Family Grant

  • Grant Type
    • Supplemental Income Grant 

    • This form is for surviving spouses of clergy seeking need-based Supplemental Income. Please answer each question completely and accurately. All information is confidential.


      For questions, contact: operations@clergyassurancefund.org. 

    • Household Information

    • Housing Information

    • Mortgage

    • Other Housing Expenses

    • Medical Expenses

    • Other Regular Expenses

    • Employment

    • Other Income

    • Savings and Investments

    • Other Sources of Support

    • Additional Income Sources

    • Additional Comments

    • Emergency Aid Grant 
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Educational Grant 
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof

  • Form Submission and Signature

  • Should be Empty: