Member Benvolence Form

Member Contact Information

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Member Employment Information

Are you employed?

Yes
No

Place of employment

Supervisor Name

First

Last

Supervisor's Phone Number

Member Worship and Ministry Information

How long have you been a member?

<1 year
1-4 years
5+ years

Which service do you often attend?

7:45am
10:45am

Do you serve in ministry

Yes
No

Please provide the name of the ministry

Are you an active financial supporter?

Yes
No

Benevolence Requested

Please included copies of bills to be considered for assistance

Bill #1 in $

Bill copy upload

Click or drag a file to this area to upload.

Bill #2 in $

Bill copy upload

Click or drag a file to this area to upload.

Bill #3 in $

Bill copy upload

Click or drag a file to this area to upload.

Have you ever received benevolence from First Metropolitan Church?

Yes
No

Amount in $

Reason

Will you be able to pay back the benevolence?

Yes
No

Member Benevolence Form

Member Contact Information

Member Employment Information

Member Worship and Ministry Information

Benevolence Requested