IRA Transfer Information Form

Kairos Benevolence Fund Application:
Ministry Type *

I'm a missionary I'm a minister I'm a retired missionary I'm a retired minister
Name of Church or Ministry that Ordained you *
PERSONAL INFORMATION
Date *

Month Day Year
Name *

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Address *

Street Address

Address Line 2

City State / Province / Region

Zip / Postal Code Country
Date of Birth *

Month Day Year
Gender

Male Female
Marital Status

Single Engaged Married Widowed
Do you have any minor children living with you?

Yes No
Number of children
Please indicate the ages of any minor children living with you
What is the name of the church you attend?
To the best of your ability, in the space provided below, briefly describe what you believe to be the most important need(s) to be met by the Kairos Benevolence Fund, the situation that created the need(s), the amount of financial assistance needed to meet the need(s), and how quickly the need(s) must be satisfied.
Have you applied to any other private or public organization to assist with meeting this need?

Yes No
If yes, please name the organization(s)
Have you met with any financial advisors or counselors to address plans for meeting your needs long term?

Yes No
If yes, please name the organization(s)
Employment Information
Please briefly describe, in the space provided below, the history of your ministry and/or missionary service together with the approximate dates, places, and names of churches and/or organizations:
Are you presently employed?

Yes - Full Time Yes - Part Time No
Are you?

Retired Disabled Unemployed Other
If you or your spouse are not Retired or Disabled, and are currently Unemployed, please briefly describe your efforts to find employment and indicate whether you are currently receiving any unemployment benefits or severance benefits from the government or a former employer.
Housing Information
Do you own the home that you are currently living in?

Yes No
Do you have a mortgage loan?

Yes No
Amount remaining on your mortgage?
i.e. $50,000
Do you own a home that you are not currently living in?

Yes No
Please indicate why
If you are not living in a home that you own, please indicate which option best describes your situation

I am living in a parsonage I am living in a rental property I am living with a family member or friend I am living in an assisted living facility I am in a skilled nursing facility Other
If you are requesting housing assistance, have you told your Lender, Landlord or other housing provider about your need?

Yes No
Please indicate how long you have lived at your present location:
i.e. 10 years
References

Please supply the name and contact information for at least 3 individuals that you would be willing for the Kairos Benevolence Fund to contact regarding your need(s). Again, please be assured that all information discussed will remain confidential.
Reference #1
Reference #2
Reference #3
Certification
How did you hear about the ministry of the Kairos Benevolence Fund?

I spoke with a KBF Representative I saw a KBF video presentation From CDF Capital From a friend From a Center for Church Leadership Representative Other
By typing your name in the box provided below you are certifying the accuracy of the information you have provided above, that you have carefully read the opening paragraphs, that the Kairos Benevolence Fund has your permission to share the details of this application with its Benevolence Fund Grant Committee, and that the Kairos Benevolence Fund may contact you, and persons you recommend, for more information.
Should be Empty:

Kairos Benevolence Fund Application:

PERSONAL INFORMATION

Employment Information

Housing Information

References

Certification