BENEVOLENCE GUIDELINES

(FOR MEMBERS)

REQUESTER: Please attach copies of statement/bills of which you are requesting assistance. This benevolence form is not a contract for assistance, nor is it a guaranty of assistance from SWC.

Benevolence Intake Form

Comments

This field is for validation purposes and should be left unchanged.

Date

Untitled

Drop-in

Phone-in

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home/Cell Phone

Country Phone Number

Have you ever received assistance from SWC?

Please state the cause or nature of your current hardship:

What steps are you taking to remedy this situation?

Have you sought help from any other churches or social organizations?

Yes

Untitled

List

Expense

Company

Amount

Do you need food assistance?

Yes

NOTICE TO REQUESTER

Please attach copies of Statements/Bills for which you are requesting assistance to this application prior to submission.
This benevolence form is not a contract for assistance, nor is it !:I guaranty of assistance form SWC. Your signature below indicates that you understand the following:
The Benevolence Committee will refer you to outside/appropriate agencies if we are unable to meet your needs, at this time.

The Benevolence Committee reserves the right to follow up on any information provided to the Committee. The Committee will be sensitive to confidential information.

The Benevolence Committee will hold you accountable for taking steps to remedy this situation.

Assistance is intended to be a gift.

Confirmation
By checking this box I affirm that all information entered is true to the best of my knowledge.