Benevolence: Grace & Peace Deacon Help Request

Grace & Peace Austin seeks to help members of the church and community in times of need. Our church's deacons meet with folks who need support during a crisis whether it be spiritual, financial, family or health related. Our goal is to glorfy God by sharing our resources as well as the Gospel of Jesus Christ.

Please note that our Deaconate is comprised of part time volunteers. Some crises may be beyond our scope and ability. We ask that you have patience with us as it may take 2-3 business days to receive a response.

Finally, if you are experiencing homelessness we recommend following this link to find many resources which can help you out- www.austintexas.gov/department/homeless-assistance. If you're having an emergency please call 911.

How did you hear about us?*

How can we be of help to you?*

Name*

First NameLast Name

Today's date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

What is the best way to contact you?*

Family Information

Marital Status*

MarriedSingle

Do you have children?*

YesNo

What are your children's ages?*

Are there other people who are part of your household?*

Do you have any extended family in the Austin area?*

Employment Information

Are you currently employed?*

YesNo

Employer Name*

Employer Contact Information*

Name and contact of person filling out this form if not recipient:

INELIGIBLE REQUESTS

Credit card debt

Automobile purchase

Long-term or recurring expenses

Cash

By signing this document I acknowledge and agree to the following statements: If requested, I will provide documentation regarding my income, expenses, and/or bank accounts.-I authorize Grace and Peace Austin (G+P) to review and share any information in the document or otherwise provided as necessary for the purpose of evaluating my request for assistance.-I understand all checks are issued directly to the vendor for rent and utilities. In emergency cases (if applicant is facing eviction or utilities are being turned off, etc.) applicant can pick the check up from the church office.-I understand an applicant will only be helped once every 12 months unless there are extenuating circumstances and the Committee approves the exception.-I promise to notify G+P of any funds or help I receive from other sources regarding this request.-I promise to use the aid I receive from G+P in connection with my request for assistance solely for the purposes I have described in this document.-I understand that G+P has the right at any time, and in its sole discretion, to deny a request for assistance, to provide non financial assistance rather than financial aid, and to change or terminate any type of aid it chooses to provide.-I understand that G+P does not discriminate on the basis of race, color, sex, national origin, age, disability, relationship with anyone in the leadership of G+P, or financial contributions to G+P.