Request for Financial Assistance

Thank you for reaching out to us with a request for assistance. Our desire at Grace is to help those who face difficult times with respect and grace.

We want to help people the best way possible and so, priority for assistance is given to those in the Smithville area. This allows us to provide ongoing help to our neighbors. This may include financial assistance, spiritual help, or some form of counseling.

Your request will be kept private and reviewed by our pastors and the benevolence team.

Your name *

Email address *

Phone Number *

Address *

FAMILY INFORMATION *

In the space provided below, please enter the names, relationships, and dates of birth of additional household members. If you have no additional household members, enter "NONE" to continue.

EMPLOYMENT INFORMATION

Please complete the following information concerning your current employment status.

Are you currently employed? *

Does the household have any other sources of income/help? Please list.

Others in the household who are employed, disability payments, food stamps, etc.

CHURCH BACKGROUND INFORMATION

Please answer the following questions your local church involvement and affiliation.

Are you a member or regular attender of a church? *

Have you previously received assistance from Grace Community Church? *

FINANCIAL REQUEST INFORMATION

Please provide the following information concerning your specific financial request.

What has happened to create this need? *

Funds need by.... *

Enter the date by which funds are needed

Purpose of Request *

For what purpose will the funds requested be used? (i.e. utilities, rent, groceries, gas, etc.)

NOTE: Copies of bills or other applicable documentation will be required before there is an approval and disbursement of funds.

Amount Requested *

Have you received assistance from any other church, Ministry or agency during the past 6 months? *

Financial Counseling *

Would you be willing to participate in financial counseling if needed?

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