Application for Benevolent Assistance

Genesis Church desires to help people in need. This application is to be submitted as a request for benevolent assistance. Genesis Church reserves the right, at its sole discretion, to grant or deny a benevolent gift to any applicant. Applications will be reviewed and decided upon by Genesis Church Elders. Application does not guarantee payment will be made on behalf of or directly to the applicant. Genesis Church policy is that cash will not be disbursed to individuals.

Name of person submitting application *

First

Last

Email *

Name of person in need of assistance (if different from submitter)

First

Last

Email of person in need of assistance (if different from submitter)

Phone of person in need of assistance *

Address of person in need of assistance

Address Line 1

Address Line 2

City

State

Zip Code

Relationship to Genesis Church (member/attender/friend of member/Eureka resident, etc.) *

Amount Requested *

Requesting assistance for (check all that apply) *

Detail of Other (selected above) or enter N/A *

Phone