BENEVOLENCE REQUEST FORM

All requests will be reviewed by the board at their next meeting. If the request is urgent or has a deadline, please make a note of that in the "describe request" box.

Sorry, we are not able to help with hotel stays.

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Most recent/Current Employer

*

If Unemployed please provide short explanation why

Maritial Status

*

Please select one option.

Married Single Engaged Partner Widowed Divorced Separated

Number of Adults in the Household

*

Number of Children in the Household

*

What is your current connection to our church?

*

Please select one option.

Memeber Regular Attender Infrequent Attender No connection

Have you received benevolence help from Grace Church in the last year

*

Please select one option.

yes no

Have you received benevolence help from any other Church or agency in the last year?

*

Please select one option.

Yes No

If so, which one?

Describe your need, including monetary amount requested.

*

Name of submitter (if not the applicant him/herself)

Description

All requests will be reviewed by the board at their next meeting. If the request is urgent or has a deadline, please make a note of that in the "describe request" box.

Sorry, we are not able to help with hotel stays.

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