901 Financial Assistance Form

Your name *

Last name

Email address *

Who is eligible for financial assistance?

901 Church has a benevolence fund which is used to provide assistance when necessary to the partners of 901 Church. Financial assistance is provided on the basis of individual needs and will take into account the individuals financial picture as a whole. In order to determine whether or not funds are allocated, a detailed review of the individuals finances will be required. We will ask for bank statements and no funds will be provided to an individual. All funds will be paid directly to the individuals provider of services (i.e. utility company, landlord etc.).

How do I apply?

Complete the form and provide your most recent bank statement as well as a copy of any bill(s) you are requesting assistance with.

Marital status

Select…SingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleSingleMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedMarriedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowedWidowed

Birthdate

Gender

Select…MaleFemale

Address

HomeWorkOther

Country

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Describe below why you need financial assistance.

If you need assistance with a specific bill, please indicate the payee and applicable account number.

Have you completed Growth Track at 901 Church?

Yes

No

Are you serving at 901 Church and if so, which one?

By filling out this form, you give 901 Church permission to share your information with appropriate team members. Your responses will be kept confidential. Please type your name below to confirm receipt of this acknowledgment.

Bank Statement Submission *

Please attach your most recent bank statement.

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