Financial Assistance Form

Application for Financial Assistance from Benevolence. By completing this form you are stating that the facts set forth are true and complete. I hereby authorize Olive Branch Community Church to make inquiries as needed to verify the information as I have stated it on this application. I also understand that false statements will be considered sufficient cause for denial of any assistance. All information supplied will be kept strictly confidential.

Your name *

Email address *

Phone number *

Address

Which pastor or staff member knows you best? *

Do you attend Olive Branch church? *

*A Partner (or Member) is someone who has fulfilled all the requirements, such as taking the class, turning in a commitment form and actively serving on a ministry team.

I am an active Partner (member) of Olive Branch

I regularly attend Olive Branch church

I attend on occasion

I do not attend Olive Branch church

Have you ever received financial assistance from OBCC before? *

Yes

Please explain the circumstances/reasons why you need financial assistance. *

Who are the members of your household? *

For example: Myself plus 3 kids (age 3, 6, 8) plus my mom.

Do you have family that might be able to help and have you asked them yet? *

Yes

I do not have family that can help

Is anyone in your household employed? *

What bills do you need help with and what is the total amount you are asking for? *

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