Application for Benevolence

Application for Benevolence
The purpose of the Benevolence Fund is to provide financial aid to an individual who is in need. The Benevolence Fund may not be applicable for cases which need long-term financial support. The entire form must be completed in order to be considered for assistance.

Applicants are not guaranteed financial assistance upon completion of this form. Focus Church has the right to adjust or decline an applicant's request, and may consider providing assistance other than monetary help. Focus Church does not discriminate between applicants based upon race, gender, sexual orientation, national origin, age, geographic territory, or disability.
PERSONAL INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Date of Birth

MonthDayYear
Gender*

MaleFemaleN/A
Employment Status*

Full-timePart-timeNot currently working/looking for work
Name of Employer
Employer's Phone Number

Area CodePhone Number
Briefly explain your work history and the circumstances preventing you from working right now*
Marital Status*

SingleEngagedMarriedSeparatedDivorcedWidowed
SIGNIFICANT OTHER'S INFORMATION
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Gender

MaleFemaleN/A
Employment Status

Full-timePart-timeNot currently working/looking for work
Name of Employer
Employer's Phone Number

Area CodePhone Number
Briefly explain your significant other's work history and the circumstances preventing them from working right now
EXPLANATION OF NEED
Funds needed for payment of:

Mortgage/RentUtilitiesMedical expensesFoodTransportationOther
If other, please explain:
Amount requested*
Date funds are needed*

MonthDayYear
Please submit a copy of the bill you are requesting assistance with here:*

Browse Files

Cancelof
Why are these funds needed?
What steps have been taken to obtain financial assistance from non-church sources?
How will you meet this (these) financial obligations going forward?
GENERAL INFORMATION
Which Focus Church campus do you attend?
Do you attend Focus Church?

Yes, regularly.Sometimes.I've come once.No, I've never been.
Have you filled out and turned in a YouCard?

YesNo
Do you attend another church?

YesNo
Church Name
Have you received financial assistance from Focus Church in the last 12 months?

YesNo
Amount received
Signature
Should be Empty:

Application for Benevolence

PERSONAL INFORMATION

EXPLANATION OF NEED

GENERAL INFORMATION