Benevolence Application Form

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Benevolence Application Form

The Benevolence Fund at WH is here to help people in this church body who are regularly attending and are actively involved in this community. These funds are intended to help meet the most urgent needs of individuals who are in short term financial distress. The information is required to process your application and will be kept strictly confidential.

Referred by

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Birth Date(Required)

Month

Day

Year

Marital Status(Required)

Number of dependent children living with you(Required)

How are you actively involved at Woodland Hills?(Required)

Check all that apply.

Covenant Partnership

Participating in classes or support groups

Involvement in a WH program or ministry (including volunteering)

Received lay counseling

Kids attending our Children’s or Youth ministries

Previous financial contributions

Other

If other, please list(Required)

For how long?(Required)

Who can verify your involvement here?(Required)

Please explain your current financial situation:(Required)

What do you specifically need help with?(Required)

Be as specific as possible. Include dollar amounts & any other information.

Is this a request for rental assistance?(Required)

Yes

Name(Required)

Please list the name & phone number of the rental manager.

First Last

Phone(Required)

By adding their contact information, you are giving us permission to contact them.

How do you see your situation improving?(Required)

What other resources have you used to meet this need?(Required)

Have you been helped by Woodland Hills Church before?(Required)

Yes

If yes, how long ago?(Required)

Please disclose the following budget information:

Income(Required)

List all forms of income, including wages, tips, public assistance, disability, social security, child support, etc.

Income Total

Assets(Required)

List all assets, including bank accounts, investments, retirement funds, personal items over $1000, etc.

Assets Total

Expenses

Please list monthly amounts due, or average amount paid.

*Include payment, gas, expected repairs, tabs, etc.
**Include small expenditures, bus fare, coffee, etc.

Mortgage/Rent(Required)

Electric/Gas(Required)

Groceries(Required)

Water/Trash(Required)

Credit Cards(Required)

Clothing(Required)

Auto*(Required)

Phone/Internet(Required)

Household(Required)

Cable/Streaming(Required)

Insurance(Required)

Toiletries(Required)

Hair/Personal(Required)

Entertainment(Required)

Miscellaneous**(Required)

Other loans/Debts owed:(Required)

Expenses Total

Thank you for filling out this form. It is very important to WH Benevolence Ministers that we are using money that is given by those in the church body with discretion and wisdom. Your cooperation allows us to determine the best way to assist you.

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Forms

Benevolence Application Form

Please disclose the following budget information:

Expenses

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