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Benelovence Request Application Form

Benevolence requests are accepted for consideration for attending members of Calvary Church.

There is a per year/per family limit. We cannot give any cash disbursements to an individual, but approved requests will be paid directly to the bill or listed business/party.

Please attach a copy of the bill or bills with the completed application. A five member benevolence team will look at your request and make a decision on your application and contact you. Please allow 3-5 business days for requests responses.

Your name *

Last name

Email address *

Applicant Information

Birthdate *

Phone number *

Phone type

Social Security # *

Driver's License# *

Name of Employer *

Marital Status *

Single

Married

Divorced

Separated

Widowed

Other

Name of spouse

Spouse's Social Security #

Spouse's Phone number

Number of persons in household *

Number of persons 17 and under in household *

Do you attend Calvary Church? *

Yes

Are you a member of Calvary Church, completed the Membership Class? *

Yes

Explanation of Need

Funds needed for payment of: *

Mortgage/Rent

Utilities

Gas

Food

Funeral Expenses

Other

Please attach bill(s) you are submitting for assistance.

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Amount requested *

Date funds are needed *

Please provide the name, address, and phone number of each party to whom requested funds will be paid. *

Please explain the circumstance in why assistance is needed. *

What steps have been taken to obtain assistance from other sources? *

How will you meet this (these) financial obligations going forward? *

Have you received assistance from Cavary Church in the past 6 months? *

Yes

Please provide three references (cannot be family and must be over 21)

Reference #1 Name

Reference #1 Phone Number

Reference #2 Name

Reference #2 Phone Number

Reference #3 Name

Reference #3 Phone Number

Application Signature and Acknowledgment

By signing below I attest to the fact that I fully understand the information being requested from me in this application process and that to the best of my knowledge I have provided the committee with accurate and honest repsonses. I also authorize Calvary Church to verify all of the information provided.

By typing my name below, I understand and agree that this form of electronic signature has the
same legal force and effect as a manual signature.

Please type your electronic signature here *

Spouse's electronic signature (if applicable)

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Calvary Church
info@visitcalvary.com
423-282-2811