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Benevolence Information Form
Please fill out form below and we will contact you after your request has been reviewed. Processing may take at lease (5) business days from this date.
Any request received and approved after Tuesday may not be processed for payment until Friday of the following week
. Copies of bills for which assistance is needed must be provided; you must provide your own photocopies. Failure to complete the entire form may delay the review of your request. Below is a link to a .pdf or the form for those who desired to write out their information and send a different way.
*
Indicates required field
Name
*
First
Last
Please enter your First and Last Name.
SS Number
*
Please enter your Social Security Number.
Spouse's Name
*
First
Last
Spouse's Name
Current Address
*
City
*
State
*
Virginia
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Select one state from menu.
Zip
*
Please enter zip code.
Home Phone Number
*
Enter home phone or cell phone number.
Email
*
Household Members
Name
*
Enter household member's first and last name. ex: "John Doe", "Jane Doe"
Relationship
*
Enter household members relationship to you.
SS#
*
Enter household member's SS#.
Date of Birth
*
Household member's date of birth.
Name
*
Enter household member's first and last name. ex: "John Doe", "Jane Doe"
Relationship
*
Enter household members relationship to you.
SS#
*
Enter household member's SS#.
Date of Birth
*
Household member's date of birth.
Name
*
Enter household member's first and last name. ex: "John Doe", "Jane Doe"
Relationship
*
Enter household members relationship to you.
SS#
*
Enter household member's SS#.
Date of Birth
*
Household member's date of birth.
Name
*
Enter household member's first and last name. ex: "John Doe", "Jane Doe"
Relationship
*
Enter household members relationship to you.
SS#
*
Enter household member's SS#.
Date of Birth
*
Household member's date of birth.
Name
*
Enter household member's first and last name. ex: "John Doe", "Jane Doe"
Relationship
*
Enter household members relationship to you.
SS#
*
Enter household member's SS#.
Date of Birth
*
Household member's date of birth.
Employment Information
Employer
*
Enter the name of the company you work for.
Employer Address
*
Enter your company's address.
How Long?
*
Enter the number of year(s) and/or month(s) you have worked there.
Employer Number
*
Enter your company's phone number.
Unemployed?
*
No
Yes
If Unemployed, How Long?
*
Enter the year(s) and/or month(s) you have been unemployed.
Reason for Unemployment
*
If not unemployed, what has happened to create this need?
*
Please explain unemployment situation.
Are you a member of Inner-Faith Fellowship Ministries?
Member of Inner-Faith:
*
Yes
No
Click "Yes," if you are a member or "no."
Are you currently tithing at Inner-Faith Fellowship Ministries?
Tithing at Inner-Faith:
*
Yes
No
Click "Yes," if you tithe or "No."
Inner-Faith Fellowship Ministries Leader?
*
Yes
No
Please click "Yes," if you are a IFFM leader or no."
Which area of ministry do you volunteer?
*
Please list the ministry/ministries you volunteer for.
Home Church (If you are not a member of IFFM)
*
Home Church Phone Number
*
Enter church's phone number.
Have you been helped previously by Inner-Faith Fellowship Ministries?
Previously helped by IFFM:
*
Yes
No
Check "Yes," if we have helped you before or "No."
Have you received assistance from any other church than Inner-Faith Fellowship Ministries' surrounding areas during the past 6 months?
Helped by other ministries:
*
Yes
No
Check "Yes," if you have received assistance from other ministries or "No."
**If yes, what ministry or agency during the past 6 month?
*
Type the name of the ministry or agency in the field below.
Amount and/or type of assistance?
*
Please enter the information about the assistance you received in the last 6 months.
Please Attached a copy of the bill(s) for which assistance is requested.
*
Max file size: 20MB
Attach copy of your bill to the form before submitting.
Upload File
*
Max file size: 20MB
Attach copy of your bill to the form before submitting.
Upload File
*
Max file size: 20MB
Attach copy of your bill to the form before submitting.
Submit
Benevelence_Information_Form.pdf
File Size:
495 kb
File Type:
pdf
Download File
Home
Our Pastors
>
Ministry Leaders
About Us
>
Our Beliefs
Our Mission Statement
Our Vision
Ministries
Inner Life Sister Circle
Men-In-Motion
Youth Ministry
Hospitality
Intercessory Team
InnerSounds Praise Team
Toney Memorial
Give
Contact Us
Guest Book
Benevolence Request
Gallery
