Financial Assistance Request

Due to a number of factors, financial assistance requests may take up to two weeks to process, so please plan accordingly. You will be contacted directly by one of our pastors regarding your request.

The Elders of The City Church have established a benevolence fund from which we can consider helping regularly attending, established members of the church with things such as rent/mortgage assistance and basic utilities at times of emergency when these basic housing needs are threatened. Before coming to the church for help it is expected that you have already approached your own family and support structure first.

Date*
MM
DD
YYYY
Which campus/service do you attend on weekends?*
Your Name*
First Last
How long have you been actively attending?
Have you attended a Members Seminar or Belong Class?
If yes, approximate date of attendance:*
MM
DD
YYYY
Do you attend a weekend service(s) weekly?*
Do you tithe ten percent consistently?*
If you are not attending or tithing consistently, please explain.
What other ways are you involved at the church? If nothing, write 'None'.*
What City Group do you currently attend or have attended most recently? If you've never attended a City Group, write 'None'.*
What email address should we use to contact you?*
What phone number(s) should we reach you at?*
What is your home address?*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What is your age?*
What is your marital status*
Where are you employed?*
What is your spouse's name? (If married)
What is your spouse's place of employment? (If married)
What are your children's ages? (If you have children)
Total Monthly Household Net Income (after taxes, deductions).*
Include any payments that you may also receive in the form of Social Security, Pensions, Annuities, Child Support, etc.
Monthly Rent/Mortgage*
Auto Payments*
Medical*
Phone*
Credit Card Debt Total*
Monthly Minimum Payment*
Other
Do you have any retirement assets that could be available for you to draw from?
I need help with:*
- Rent/Mortgage
- Utilities
- Other
Please explain if you selected "Other".
Deadline*
MM
DD
YYYY
Total Amount Requesting*
Have you previously been helped by The City Church?
If yes, what did you receive and when?
Have you ever attended a Financial Peace University City Group?
If yes, who was your Financial Peace University City Group leader?
Please explain the circumstances that brought about this current need.*
What other sources have you sought help from to meet this need?*
- Family (Parents, Adult Children, Siblings, etc.)
- Friends
- Other churches or agencies, etc.
Please provide more information about each checked item:*
Please provide billing information for the bills you are requesting help with. The City Church does not distribute cash or personal checks.
1 / Company Name*
Phone Number*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Contact Person
Total Amount Due*
2 / Company Name
Phone Number
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Contact Person
Total Amount Due
3 / Company Name
Phone Number
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Contact Person
Total Amount Due
Please list two personal references from The City Church. These individuals may be contacted regarding you.
1 / Name
First Last
Relationship to You
Primary Phone Number
Secondary Phone Number
2 / Name
First Last
Relationship to You
Primary Phone Number
Secondary Phone Number
Plan of Action*
List your plan of action for dealing with this need to ensure it is not recurring.