theChapel – Financial Request

Financial Request.

Guidelines & process

In the interest of helping others, we do have a “financial need fund”. God’s people have lovingly donated money to this fund, and we view it as God’s money, not ours. Therefore, it is not to be given away unwisely, but with prayer and loving discernment.

Here are some important principles that are essential for you to understand. These polices are intended to be a responsible way for us to discern needs and use God’s money wisely.

We may help you, and this is how we do it.

The main reason we exist is to encourage you to walk with God.
We will treat you with dignity and respect. Therefore, abuse or aggressive language or actions will not be tolerated.
We will not give cash.
We do not say “yes” without prayerful evaluation, that also includes asking you to fill out a request form and giving us permission to verify the information that have stated. The process takes at least 48 hours and in some cases, up to a week. We involve theChapel Board in assessing the use of the church’s money.
Our intention is to help with what we deem as needs not wants and desires. That means we don’t pay bills we deem unnecessary.
We will ask for you to take primary responsibility for your needs, and then turn to your family, BEFORE we involve the church funds.
God has placed theChapel is THIS community. There are churches in other communities who minister to those in their area.
Photo ID will be required to process your request.

We don’t want to see you continue in a bad financial situation. Therefore, we want to know:

Other agencies and help programs from which you have sought help
Your job and family situation
How you met this need last month and how you plan to meet it next month

If you wish to continue with this process please:

Fill out the Financial Need Request Form.
Sign the Release of Information Form & accept the policies stated above.

We will begin seeking ways to help you meet your needs.

PERSONAL INFORMATION
Name:*
First Last
Your Spouse Full Name (if applicable)
First Last
Date*
MM slash DD slash YYYY
Address:*
Street Address Address Line 2 City State ZIP Code
Social security number:*
Email*
Phone: Daytime*
Phone: Work
Phone: Evening
Gender*
Date of birth:*
MM slash DD slash YYYY
Age:*
Marital status:*
SPOUSE INFORMATION
Spouse Name:*
First Last
Address:*
Street Address Address Line 2 City State ZIP Code
Spouse Phone:*
Gender:*
Date of birth:*
MM slash DD slash YYYY
Age:*

Please list your specific requests:*

Amount Requested	Purpose:	Date Needed:

Click the plus button to the right to add multiple requests.

What events led to your need for assistance?*
Have you received assistance from theChapel in the past?*
When & what assistance did you receive?*

List

Name:	Age:	Date of birth:	Relationship:	Monthly Income:

ADDITIONAL INFORMATION
Have you seen a financial counselor within the last six months?*
If so, with whom?*
What steps are you taking to improve your present situation?*
Have you contacted anyone else for assistance within the last six months?*
- None
- Family
- Churches
- Friends
- Agencies
What is the name of your church?*
Church phone number:*
Do you attend regularly?*
How frequently do you attend per month?*
Who suggested that you contact theChapel?*
What is your relationship to the person that referred you?*
Phone number of person that referred you:*
How would you describe your current relationship with Jesus Christ?*
May we contact your friends and/or listed references?*
Do you have physical or emotional issues that hinder you from meeting your financial needs?
Explain:*
Are you willing to participate in a self-help program?*

References, names and phone numbers (other than relatives):*

Name	Relationship	Phone Number	Years Aquainted

EMPLOYMENT HISTORY
Name of present/ most recent employer:*
Name of Supervisor:*
First Last
Supervisor Phone Number:*
Address of present or most recent employer:*
Street Address City State / Province / Region ZIP / Postal Code
Are you currently employed?*
Start of employment date:*
MM slash DD slash YYYY
Position & job description:*
Position & job description:**
HOUSING
What is your current living arrangement?*
How long have you been at your present address?*
Name of Landlord/ Mortgage Company (if applicable)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Do you have access to a car?*
MONTHLY INCOME
Job #1: take home pay*
Job #2: take home pay (if applicable)
KTAP:
Child support (if applicable)
Retirement:
Social Security
SSI/ Disability:
Food Stamps
Please list any other means of monthly income:
Total amount of monthly income:
Frequency of payment per month:
MONTHLY EXPENSES
Tithes/Contributions:
Rent:
Mortgage:
Car Payment:
Auto Insurance:
Auto (gas & oil):
Electric/Gas:
Water:
Food:
Phone:
Cable TV:
Day Care:
Child Support:
Furniture/ Appliances:
Credit Cards:
School Loans:
Bank Loans:
Finance Co. Loans:
Other Monthly Expenses:
Total Monthly Expenses:
I authorize theChapel to verify all information provided.
This is not a contract for assistance. I understand the terms stated above under which I may seek assistance from theChapel.
Signature:*

Financial Request.

Financial Request.

Guidelines & process

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