Benevolence

Contact

First Name

Last Name

Phone Number

Address

Apartment, suite, etc.

City

State

Postal / Zip Code

Gender

Marital Status

Best contact method

Today's Date

Deadline for Assistance

How much are you asking for in assistance?

Briefly, explain your needs and what led you to request assistance. We will be praying for you and providing counsel where needed.

Are you willing to receive financial counseling?

Have you previously made a request of VIBEZ Church for financial assistance?

Was your previous request granted?

How much did you receive?

Date of previous request

Your religious beliefs, practice or association will NOT in any way factor into our decision. This information is simply informative.

Do you have a personal relationship with Jesus Christ?

Are you a member of the VIBEZ Church family?

What church do you attend?

Would you be open to one of our family members reaching out to share about Jesus?

I declare that the above stated information is completely accurate to my knowledge.

Signature