Benevolence Request

Please fill out this form if you would like to be considered for financial assistance. Applications will be reviewed on a weekly basis. We will contact you if we can meet your needs.

Your name *

Last name

Email address *

Phone number

Phone type

Address

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Birthdate

Gender

Marital status

LP Campus

Do you attend Living Proof Church? *

Yes

Do you have a personal relationship with Jesus Christ? *

Yes

I would like more information

Are you willing to receive financial counseling? *

Yes

Have you currently sought assistance elsewhere for this need? If yes, please describe below. *

Previous Assistance *

In the last twelve months, have your received assistance from Living Proof Church? If yes, please describe below.

What circumstances led to you needing assistance?* *

Current Employer *

Please list your current or most previous employer below.

Financial Status *

Please provide a brief summary of your current financial status. Please include total weekly household income?

Total number of people in your household? *

Numbers only

Type of Request *

Food

Transportation

Housing Support

Utilities

Statement of need *

Briefly describe your recent hardship or extraordinary circumstance.

Checks will not be issued to any individual. They must be made out to business or entity requested.

Please list the name of businesses and amounts for your request. *

Is this an emergency? *

Requests are reviewed weekly except in the case of an emergency. Is this request urgent in nature?

Yes, this request is urgent, please process immediately

No, this can be processed at the next scheduled review

Where do you attend church? *

Has your home church helped you within the last 12 months? *

Living Proof
livingproofpaola@gmail.com
9139377312

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