Benevolence Request

Please read the Evident Life Church Benevolence Guidelines prior to completing and submitting this form. The program guidelines are found at: https://www.evidentlife.org/wp-content/uploads/2022/10/BenevolenceGuidelines2022.pdf

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Gender

Marital Status

Single

Married

Members of Houshold

Do you regularly attend Evident Life Church (2 or more times monthly in person)?

Yes

No

How long have you been attending Evident Life Church?

Less than 1 month

1 - 3 months

Longer than 3 months

Are you consulting with a staff member at Evident Life Church as a part of your process?

Yes

No

Which staff member are you consulting with?

Are you currently employed?

Yes

No

Name of Employer

Address of Employer

Phone number of employer

How long have you been unemployed?

Reason for unemployment

Have you recently applied for employment at other places?

Yes

No

What other places have you recently applied for employment?

Have you previously received assistance from Evident Life Church?

Yes

No

Last date that you received assistance from Evident Life Church

Please briefly describe your current life situation

List any expenses that are past due, or are due in the next three weeks

Which bill(s) you are currently seeking assistance for?

Date that assistance is needed by

Amount of assistance requested

Have you sought assistance from any other sources (relatives, individuals, charities, or agencies)?

Yes

No

Please list the names of those relatives, individuals, charities, and/or agencies

Please describe any efforts you have taken to negotiate delayed payment for bills, or to seek other income.

Signature