GracePointe Church - Assistance Form

First Name

Last Name

Today's Date

Gender

Birthdate

Email

Phone Number

DL#

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Veteran

Relationship Status

List the name, birthday, & relationship for all residents in your home

Have you ever been saved?

Name of the church you attend

How long have you attended:

Pastor's name:

City:

Employer:

Employer address:

Employer's phone #:

Monthly income:

Salary:

Unemployment:

SSI:

Child Support:

Food Stamps:

Workman's comp:

If unemployed, are you actively seeking employment?

Would you like assistance finding a job?

What is your need?

How much is your need?

Have you spoken with your family about your need?

Have you spoken with Dept. of Family Services?

If yes, when & with whom?

Have you sought assistance from any other churches in the area?

If yes, when & where?

If you attend another church, have you sought assistance from them?

Permission to contact your Pastor?

Pastor's Contact:

Have you received help from GracePointe in the past?

Is there anything else you'd like us to know about your situation?

NOTE:
Our church is not a Government assisted agency. All resources are a result of direct donations of our Congregation.

Fill Out:
Name 2 people who are not family members that can confirm this need:

Name & Phone Number:

Notice:
The above information is true to the best of my knowledge, and I authorize the release of any information necessary to verify statements given on this application. I realize that any deliberate misrepresentation (dishonesty) of these circumstances, when discovered, will void my application for assistance

Signature

IMPORTANT

PLEASE SUBMIT A PICTURE OF YOUR PHOTO ID AND ANY OTHER BILLS OR PAPER WORK RELATED TO THIS REQUEST!
To: info@gracepointechurch.org (We must have this information to consider and process your request)

We also require you to come to at least 1 church service we have here. Please call the Office at (912) 393-3601 for questions about service times

NOTE:
Our church is not a Government assisted agency. All resources are a result of direct donations of our Congregation.

Fill Out:
Name 2 people who are not family members that can confirm this need:

About

Service Times

Contact Info

Follow Us

NOTE:Our church is not a Government assisted agency. All resources are a result of direct donations of our Congregation.

Fill Out:Name 2 people who are not family members that can confirm this need:

About

Service Times

Contact Info

Follow Us

NOTE:
Our church is not a Government assisted agency. All resources are a result of direct donations of our Congregation.

Fill Out:
Name 2 people who are not family members that can confirm this need: