Benevolence Application Form - Spring Lake Church

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Spring Lake Church Monthly Expense Report * Expense Category Monthly Payment Current Amount Due Percent of Income Bill Attached Rent / Mortgage Utilities: Electricity Utilities: Gas Utilities: Water Utilities: Cable / Internet Phone / Cell Phone Car Payment 1 Car Payment 2 Gasoline Auto Insurance Home / Renters Insurance Health Insurance Groceries School Lunches Medical Child Care Child Support Consumer Loans: (Balance $ ______________) Credit Cards: (Balance $ ______________) Memberships (Gym, Spa, etc.) Other Expenses (Explain purpose) Total Monthly Expenses Created: March 7, 2013 (Revised 1/14/13) Page 10 of 12 1 SLC Benevolent Application w-Cover Letter.docx
Assistance by others * Spring Lake Church Have you been assisted by any other church/agency/organization? Please list all churches, agencies, or organizations you have contacted for assistance. Provide the agency name and the name/phone number of the person you contacted. If you are a member or regular attender of another church, you must apply there first. If you are not an SLC member or regular attender and you live outside of Northeast Wisconsin, you must contact organizations in your own county before we will accept your application. Churches/Agencies/Organizations Contacted * I. Church / Agency: Person contacted: Phone: II. Church / Agency: Person contacted: Phone: III. Church / Agency: Person contacted: Phone: Landlord/Mortgage Contact Information * Name of Apartment/Mortgage Company: Phone: Mailing Address: Contact name: Before you bring in or mail your completed form, make sure you have attached the following documents to the application in this order: A color photocopy of the driver’s license or other photo ID for every adult living at your address. SLC staff will make photocopies of the ID’s if you need help. A completed and signed Release Authorization for every adult living at your address. Photocopies of current (less than 30 days old) bank statements, unemployment or Social Security statements, or pay stubs to verify income for every adult living at your address. Photocopies of current (less than 15 days old) bills that you want considered. If you are requesting rent assistance: a photocopy of your lease agreement and a copy of the statement reflecting the current balance including late fees. Created: March 7, 2013 (Revised 1/14/13) Page 11 of 12 1 SLC Benevolent Application w-Cover Letter.docx
Page 1 and 2: Spring Lake Church APPLICATION FOR
Page 3 and 4: Spring Lake Church Attention: Pleas
Page 5 and 6: Spring Lake Church 4 Attend Other C
Page 7 and 8: Spring Lake Church Created: March 7
Page 9: Spring Lake Church Created: March 7
Page 13 and 14: RELEASE AUTHORIZATION Spring Lake C

Benevolence Application Form - Spring Lake Church

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