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Benevolence Application for Assistance
The Benevolence Fund at Daily Church is here to help provide assistance to people who are regularly attending Daily Church and those that are a part of the immediate community. These funds are intended to help meet the most urgent needs of individuals who are in short term financial distress. The information in this form is required to process your application and will be kept strictly confidential.
Referred by:
First Name
Last Name
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Phone Number
Email
Birthdate
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Marital Status
Single
Married
Widowed
Separated
Divorced
I'd rather not say
Number of dependent children living with you:
Do you actively attend Daily Church?
Yes
No
For how long?
0 - 6 months
6 months - 1 year
1 - 3 years
3 years +
Do you know any Daily Church staff or attendees we may contact as a reference if needed?
Are you involved in any ministry activities or small groups at Daily Church?
Yes
No
Are you a member of Daily?
Yes
No
Explain your current financial situation:
Can any of your relatives assist you? If so, in what way? If not, why?
What do you specifically need help with? (Be as specific as possible. Include $ amounts and other info.)
Is this a request for rental assistance?
Yes
No
Please list the name and phone number of the rental manager:
How do you see your situation improving?
Have you been helped by Daily Church before?
Yes
No
How long ago?
Are you currently employed?
Yes
No
Present employer:
Please list previous employer and reason for present unemployment:
Income Summary:
Please list monthly amounts of the following income sources
Employment:
Family Assistance:
Welfare:
Unemployment:
Food Stamps:
Other:
Total Monthly Income:
Expense Summary:
Please list monthly amounts of the following expenses
Mortgage/Rent:
Electric/Gas:
Water/Trash:
Groceries:
Credit Cards:
Clothing:
Auto:
Phone/Internet:
Household:
Cable TV/Streaming Services:
Insurance:
Toiletries:
Miscellaneous/Other:
Total Monthly Expense:
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GENERAL HELP REQUESTS
Use this simple form to communicate your need and we will get back to you.
First Name
Last Name
Email
Message
Submit
National Suicide
Prevention
Lifeline
1-800-273-8255
Crisis text line
Text "HELLO" to
741741