Real Life Ministries Treasure Valley Request for Benevolence

Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Phone

(###)

###

####

Preference for contact

Check all that apply.

Phone Call

Text

E-mail

Do you currently attend Real Life Ministries?

Yes

No

If you do not attend Real Life Ministries, do you have a church home?

Yes

No

N/A

Have you applied for aid or assistance at your church?

Yes

No

N/A

If you do attend Real Life Ministries Treasure Valley, are you in a small group?

Yes

No

N/A

Is your small group leader aware of your financial need?

Yes

No

N/A

May we contact your small group leader?

Yes

No

N/A

Have you applied for assistance from Real Life Ministries Treasure Valley before?

Yes

No

Do you have any other income (alimony/child support/SSI/SSDI)?

Yes

No

Do you receive housing assistance?

Yes

No

Do you currently participate in any welfare programs?

Yes

No

Do you receive free or discounted childcare or other family services?

Yes

No

Have you sought assistance from your family?

Yes

No

Supervisor's Phone

(###)

###

####

Are you receiving unemployment?

Yes

No

Marital Status

Married

Single

Separated

Divorced

Widowed

Living w/Partner

Any other adults living with you?

Yes

No

Do they work?

Yes

No

N/A

IF APPROVED, date check is needed?

(Please remember this could take up to 2 weeks for approval. You may need to make other arrangements if less than 2 weeks is needed for a payment.)

MM

DD

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