Cornerstone Community Church Benevolence Request Form

This form is a private request for financial assistance. The deacons and elders will review your request and reply ASAP. Please fill out this form and click submit.

Name

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Address

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Phone

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Email

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This address will receive a confirmation email

Do you have personal relationship with Jesus Christ?

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Please select all that apply.

Yes No I'd like to know more

Are you a member of Cornerstone Community Church?

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Please select all that apply.

Yes No

What is your relationship to Cornerstone?

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Please select all that apply.

Never Attended Visited Once Attend Sometimes Regular Attender

In your opinion which best describes your financial situation?

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Please select all that apply.

Short term emergency Short term problem Long term problem

What is the total amount you need help with?

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What is it for?

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Who should we make the check payable to:

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Attach Receipt or Invoice

Upload (8MB)

Tell us a little about yourself

Are you interested in receiving financial counseling to help get your finances under control?

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Please select all that apply.

Yes No

Are you currently Married

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Please select all that apply.

Yes No Separated

If married, is your spouse employed?

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Please select all that apply.

Yes No Full-Time Part-Time

How many people are in your household?

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Name of employer

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What is your weekly income?

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Briefly, explain your needs and what led you to request assistance at this time. We will be praying for you and willing to provide counsel where needed.

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Please provide your full name as an electronic signature.

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If married, please provide spouse's full name as an electronic signature.

*

Description

This form is a private request for financial assistance. The deacons and elders will review your request and reply ASAP. Please fill out this form and click submit.

Please Fix the Following

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