Request for Financial Help - A Benevolence Form Sample

Every church is flooded with requests for financial aid.  Many, many people will simply go from church to church asking for a hand out.  These are not often the needy, but people who are taking advantage of the church's good spirit of grace and service.  Given the limited financial resources in any congregation, how do we act as good stewards providing funds to those who need it?

Here is a form that can help limit those who simply want to abuse the church's good nature.

FINANCIAL ASSISTANCE REQUEST

 

 

1.    Assistance resources are very limited. We do not guarantee financial assistance.

2.    Priority is given to members & active participants of our congregation.

3.    It will take at least one week to evaluate, approve and process all requests (because the approval must be through committee of church members and staff, and not simply staff members)

4.    If your request is approved, you will need to provide a copy of your bill.

5.    You must come to the church office to fill out this request form.

 

Date ____________________________

 

Social Security Number _______________________

Name _________________________________________Phone _______________________

Address ____________________________________City/State/Zip _____________________

 

Connection to our church?

Member? Yes___ No___

Regular attender? Yes___ No ___

Other/

 

How did you hear about us?

 

Have you received assistance from us before? _______

When? _______

For what?

 

Married __ Single __ Divorced __Other __ Children? _____

 

Ages of children:  _______________________

 

Employer _____________________________

 

Employer’s phone number ________________

 

Amount needed $ ________________

Date needed: ___________________________

 

Why do you need what you have requested?

 

 

 

 

 

What are you doing to correct your financial situation?

 

 

 

 

 

What other sources have you gone to for help?

 

 

 

 

Check payable to:         _______________________________

 

Mailing address for check:

                                     

 

 

 

 

PLEASE RETURN THIS REQUEST TO RECEPTIONIST

To be filled out by church staff

Date __________________ Interviewer ___________________________________________

 

Interview comments __________________________________________________________

 

Action taken:_________________________________________________________________