Benevolence Application Form

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. First Century Church has the right to adjust or decline an applicant’s request, and may consider providing assistance other than monetary help. First Century Church does not discriminate between applicants based upon race, gender, sexual orientation, national origin, age, or disability.

PERSONAL INFORMATION

First Name (required)

Last Name (required)

Street Address (required)

City (required)

State (required)

Zip (required)

Your Email (required)

Phone Number (required)

Date of Birth (required)

Gender (required)
MaleFemaleN/A

Employment Status (required)
Full-TimePart-TimeNot currently working/looking for work

Marital Status (required)
SingleEngagedMarriedSeparatedDivorcedWidowed

EXPLANATION OF NEED

Funds needed for payment of:
Mortgage/RentUtilitiesMedical ExpensesFoodTransportationOther

If "Other", enter need here:

Amount Requested:

Date funds are needed:

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

Do you attend First Century Church?
Yes, regularlySometimesI've come once or twiceNo, I've never been

Have you received financial assistance from First Century Church in the last 12 months?
YesNo

AGREEMENT

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 accurate and honest responses.

Your request will be reviewed and you will be contacted if more information is needed. If your request is approved, it may take up to two full weeks to receive funds.

Check box if you agree with above statements/terms
I agree

Signature (typed name serves as signature)

Contact Us