Benevolence Fund Request Form

Please complete this form in its entirety. A pastor or staff member will contact you if there are next steps regarding your request and if additional information is needed. We are not able to fulfill every request, but we will reach out if we are able.

Your name *

Email address *

Phone number *

Address *

Are you currently a member of City Church? *

Who is your LifeGroup Leader? *

Have you brought this request/need to your LifeGroup? *

Yes

Are you currently employed? *

Marital status *

Total monthly household income *

Total monthly household expenses *

Which of the following best describes your current circumstances? *

Short term/immediate emergency

Long term financial trend

Ongoing need

Other

Please describe your financial situation and/or current need *

Is your request an overhead cost (rent, utilities, loan payment, etc.) or physical need (groceries, medical, transportation, etc.)? *

Financial assistance may be provided in the form of goods and services for physical needs, or monetary assistance for overhead costs. Our policy for financial assistance is that no cash is given for assistance requests, and payments can only be made directly from City Church to the vendor in the form of a check or card payment.

Please provide vendor and account details

ex. KUB: 1234567890

Please upload necessary or relevant files

No files currently selected

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

Total amount requested ($) *

Is this request urgent? *

If asked, are you willing to receive financial counseling from a member of our finance team? *

Any additional information we should be aware of?

I, hereby, declare that the information above is true and complete *