Benevolence Request Form

Name

Age

Male Female Couple

Address

Phone

This address will receive a confirmation email

Spouse's Name (if applicable)

Names and Ages of Children at Home (if applicable)

If there are other people living in your home, please list them here and your relationship.

Are you a member of Thornapple?

Yes No

If you are not a member of Thornapple, are you a regular attender? Yes No

How long have you been a member and/or regularly attending Thornapple?

If you are not a member/regular attender, are you connected to Thornapple in some way? (please explain) And if not, how did you hear about us or decide to contact us?

Have you been previously assisted by Thornapple? Yes No

If yes, when?

What help was given?

Have you or your household/family received assistance from other churches/agencies in the past year?

Yes No

If yes, what was the help for?

What is your current need for assistance?

What steps have you taken to remedy the situation?

Please note: Thornapple Covenant Church does not give cash or checks directly to a person. We will consider a direct payment for a bill (i.e., rent, medical, utilities)

Description

The Thornapple Covenant Church benevolence fund is intended as a source of last resort, to be used when the family or individual requesting assistance has explored all other possibilities of help from family, friends, savings, or investments. It is intended to be a temporary help during a time of crisis.

Assistance from the benevolence fund is intended to be a one-time gift. In unusual circumstances, the benevolence fund committee may decide to help an individual or family more than one time. However, under no circumstance is a gift from the benevolence fund to be considered a loan.

In order of priority, recipients of funds disbursed from the benevolence fund at the direction of the benevolence fund committee are:
1. Church members
2. Regular attenders
3. Members of the community

Benevolence Request Form

Description

Please Fix the Following