June 2026-In Christ's Way

Financial Assistance Application
Please direct all questions about In Christ's Way to info@inchristsway.org. Contacting the email above directly is the best way to receive accurate information.
IMPORTANT

Please read carefully before continuing
- Answer every question completely
- Upload all required documentation
- Incomplete applications and/or missing documentation will not be reviewed
- Any application containing false information will be rejected
- Submitting this form does not guarantee assistance

Basic Information
Today's Date

MonthDayYear
Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Current Age
Last FOUR digits of Social Security Number
Current Address

Street Address

Street Address Line 2

CityState

Zip Code
Move in Date

MonthDayYear
County Name
County Name
Phone Number
Format: (000) 000-0000.
Email
IMPORTANT: Ensure email address is correct.
Upload your drivers license

Cancelof
Total Amount Requested
Total Amount of financial assistance are you requesting from In Christ's Way
BILLS-Auto Calculated
Itemized Bills Requested

Other
Mortgage Amount Requested
Mortgage Account Number
Mortgage Lender
Billing Company's Name
Lender's Address

Street Address

CityState

Zip Code
Rent Amount Requested
Leasing Agent
Billing Company's Name
Rental Company's Address

Street Address

CityState

Zip Code
Power Amount Requested
Power Company
Billing Company's Name
Power Company's Address

Street Address

CityState

Zip Code
Power-Account Number
Account number found on power bill
Web Access Code
Found on front page of power bill
Gas Amount Requested
Gas Company
Billing Company's Name
Gas Company's Address

Street Address

CityState

Zip Code
Gas Account Number
Account number found on gas bill
Water Amount Requested
Water Company
Billing Company's Name
Water Company's Address

Street Address

CityState

Zip Code
Water Account Number
Account number found on water bill
Other Amount Requested
Other Bill Payees
Upload Mortgage Bill

Cancelof
Upload Rent Bill

Cancelof
Upload Power Bill

Cancelof
Upload Gas Bill

Cancelof
Upload Water Bill

Cancelof
Upload Other Bills

Cancelof
How much can you pay towards each bill?
I authorize In Christ's Way, as a CharityTracker Participating Agency, to share my basic, identifying, and non-confidential service transactions/information with other CharityTracker Participating Agencies.

Employment and Household Income
Total Weekly Work Hours
Check All That Apply
Proof of Income-Pay Stubs/Benefits Letter

Attach a copy of the last TWO pay stubs you received here or SSI/SSDI Benefits Letter
Cancelof
Current Place of Employment
Enter the name of the company you work for
Applicant's take home pay each MONTH
Please enter the monthly total only!
Job Title and Duties Performed
Enter job title and briefly describe your job duties
Start Date for Current Job/SSI Benefits

MonthDayYear
Do you receive any other type of income (Government Assistance such as SSI or Food Stamps, Retirement or VA Benefits, Child Support)?
Check all of the following types of income that you receive
Food Stamps Monthly Amount
Enter total amount of food stamps received each month.
Attach Food Stamps Benefits Letter

Please attach a picture of your benefits letter here
Cancelof
SSI Monthly Amount
Enter total amount of SSI received each month
SSI Beneficiary Name and Relationship to Applicant
Enter the name AND relationship of the person who receives SSI
SSDI Monthly Amount
Enter total amount of SSDI received each month
SSDI Beneficiary Name and Relationship to Applicant
Enter the name AND relationship of the person who receives SSDI
TANF Monthly Amount
Enter total amount of TANF received each month
Child Support Monthly Amount
Enter total amount of child support received each month
Retirement Benefits Monthly Amount
Enter total amount of Retirement Benefits received each month
VA Benefits Monthly Amount
Enter total amount of VA Benefits received each month
Other Monthly Amount
Enter total amount of any other income not listed above
Other Income Source
Please specify who or what provides this income. Make sure this is a separate source from any income listed above
BENEFITS TOTAL
Auto Calculated

Type of Need and Crisis
Have you ever been assisted financially by In Christ's Way in the past?
When and how were you assisted?
Please describe in detail the emergency or events beyond your control that caused you to fall behind on your bill(s):
To help us accurately assess your request, please include timelines, relevant details, and upload any documentation below that helps us understand and verify your situation
Attach documentation of your emergency here. Upload any documentation that helps us understand and verify your situation.

NOTE: Do not upload the bills you are requesting to be paid here. Upload things such as medical bills, auto repair invoices, police reports, etc. If you have more than 5 documents that need to be uploaded, please email remaining documents to assistance@inchristsway.org
Cancelof
What is your plan going forward to cover your expenses:
Do you have a church home?
Name of the church you attend
Have you asked your church for financial help?
Briefly explain how they have helped
How did you hear about the In Christ's Way financial assistance program?

Household & Previous Employment
Marital Status
If married, divorced, widowed or separated, since what date?

MonthDayYear
TOTAL adults living in the home
How many living in the home are 18 years or older? List all each adult (excluding the applicant) below.
Other Adult's Information
TOTAL children living in the home
Include all children (17 and under) currently living in the home.
Children
Previous Employment-Last 3 Years
Other Adult's Previous Employment-Last 3 Years

Budget Sheet

Please fill out the household monthly expenses in the blanks below. You can estimate if needed. If it is not a monthly expense for you then please input 0 in the blank provided.
Total Monthly Income
IMPORTANT! Please enter the sum of ALL sources of income here.
INCOME TOTAL
Auto Calculated Wage+Benefits from Page 2 (compare to Budget Sheet Income)
Mortgage
Rent
Power
Gas
Water
Mobile Phone
Internet
Cable
Car Payment
Car Insurance
Child Care
All Other Loan Payments
Groceries
EXPENSES TOTAL
AUTO Calculated from Page 5
Budget Sheet Disposable
Applicant Entered Data
DISPOSABLE TOTAL
AUTO calculated INCOME - EXPENSES (as entered by applicant)
If the amount requested on your application is approved by the Ministry Team, will you be caught up on all bills?
Signature
Comments
Ministry Team Notes
Should be Empty:

Financial Assistance Application

IMPORTANT

Basic Information

Employment and Household Income

Type of Need and Crisis

Household & Previous Employment

Budget Sheet