Maple Avenue Christian Church Benevolence Ministry

Purpose:

Maple Avenue Christian Church Benevolence Ministry desires to assist in meeting the needs of those who are encountering a financial hardship without creating a financial dependency and to create an awareness of a spiritual need for Christ. Our resources are supplied by the generosity of our congregation, and therefore, we are careful to distribute those resources wisely, and to be accountable to our congregation for the manner in which they are used in short we are responsible for being good stewards of what God blesses us with.

Application Process:

1. Be complete. Leaving out information will slow down the verification process.
2. Be honest. Misrepresentation of information will result in termination of your application i.e., not revealing all names of those living in your household, your earnings, or not reporting other agencies that have assisted you in the past.
3. Supply proper documentation. If you need assistance with rent supply landlords name, address, and phone number. If you need assistance with a utility bill, please provide a copy of your most recent bill.
4. Be sure to sign your name. Your signature gives us permission to verify the information you have given, which is required in order for your application to be considered.
5. A phone number is required. We must have your phone number in order to schedule an appointment with you to meet with one of the ministry staff. If you have no phone or no access to a phone then we will mail you a letter establishing the date and time of your scheduled appointment.
6. Be on time. Other appointments may be scheduled on the same day as your appointment so it is pertinent that you be on time.
7. Do not call the church office. The church will contact you when we have verified your application and are ready to schedule an appointment with you.
8. Providing updated information. Feel free to call the church if your income, phone number, address, or need changes.

After completing an application, it will be reviewed, based on a first-come, first-serve basis. All information must be verified for accuracy. We will try to address your need as quickly as possible, and we will call you when your application has been processed and an appointment with a minister is available. Filling out an application does not guarantee that you will receive financial assistance. We are always happy to offer prayer, and sometimes counseling to help you better cope with your situation.

We are more concerned in helping you with your situation rather than addressing a result of a possible situation, so we will strongly encourage everyone to complete a stewardship class.

Benevolence Application

Applicant Information

Driver's License Number

Today's Date

Name:

Date Of Birth:

Phone:

Current Address:

Housing Status:

Own Rent Other

Mortgage/Rent

How long have you lived there?

Gender: Male Female

Age:

Access to a car: Yes No

If you are disabled, describe your disability:

Employment Information:

Current Employer:

Employer Address:

How long?

Employer Phone

Employer Email

Employer Fax Number:

Position:

Employment Status: Hourly Salary

Annual Pay:

Spouse Information

Spouse Name:

Date of Birth:

Phone

Current Employer:

Employer Address:

How long?

Employer Phone:

Employer Email:

Employer Fax:

Position

Employment Status Hourly Salary

Annual Pay

Children in the Household:

Name

All Others Living in the Household:

Name

Financial Information:

Primary Financial Need

Rent Utility Bill Gas Medicine Other

For a utility bill, please provide the following information, along with a copy of your most recent bill.

Name of utility company

Phone number of company:

Account number:

Amount due:

Date due:

If you marked other, describe your need:

Please describe the circumstances that leave you in need today.

Benefits From Other Sources:

Unemployment:

Food Stamps:

Child Support:

Workmen's Compensation:

Social Security:

SSI:

Aid for Children:

Disability:

Medical Card for Adults:

Medical Card for Children:

Benefits From Local Sources:

Agency and Action Taken

Landlord Information:

Regardless of your need, please complete the following:

Landlord's Name:

Landlord's Address:

Landlord's Phone:

Landlord's Email:

Landlord's Fax:

Unemployment Information:

If unemployed, are you seeking employment? Yes No

Please state the reason or reasons for leaving your last job.

What type of job are you currently seeking?

What steps have you taken to seek active employment?

Church Relationship

Do you attend church? Yes No

Where do you attend?

Have you asked your church for help? Yes No

What kind of help have you received from your church?

Describe your relationship with Jesus?

Income/Expense Worksheet

Income and Social Benefits (Enter as monthly)

Income from employment?

Assistance from the State?

Assistance from the Federal Government?

Disability?

Unemployment?

Child Support?

Total monthly income/benefits.

Expenses

Food

Rent

Electric

Gas

Wired Phone

Cell Phone

Cable TV

Internet

Storage Rental

Auto Fuel

Auto Payment

Auto Insurance

Home/Renter's Insurance

Entertainment

Dining Out

Tithes or Charitable Giving

Alcohol Products

Smoking Products

Total Expenses

Difference (+/-)

RELEASE OF INFORMATION
My signature below indicates that I give permission to the Benevolence Ministry of Maple Avenue Christian Church to discuss information included on this form with other agencies/churches to disclose information they have recorded about me. I understand that Maple Avenue Christian Church only discusses details of my situation in order to help me.

Signature required upon arrival:
X_____________________________
Date:___________________________

Maple Avenue Christian Church Benevolence Ministry

Description

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