Benevolence

 
At The Gate Church we believe that we have a mandate from God to assist those who are in need, and as such, we adopt a prayerful, nonjudgmental, highly confidential approach to each request with a desire and intent to not just see the need met but also to equip the individual with tools to remedy their situation.
 
Please fill out the form below to the best of your ability and click “submit” when you are done.

Date

Name

Address

Email

Gender
 Male Female

Birth Date

Age

Marital Status
 Singled Engaged Married Divorced Widowed Separated

Spouse Name

Spouse Address

Spouse Phone

Spouse Email

Please Check Specific Needs Required at This Time

Please List Specific Amounts and Details Needed for Selected Areas

List Everyone Who Lives in Your Household
Name Date of Birth Relationship Income

Explain How You Came to Be in This Financial Situation

List Everyone Who Lives in Your Household
Name -Date of Birth -Relationship -Income

Present / Most Current Employer

Employer Phone

Supervisor

Supervisor Phone

Employer Address

Position and Job Description

Reason for Leaving (if not currently employed)

Spouse Present / Most Current Employer

Employer Phone

Spouse Supervisor

Spouse Supervisor Phone

Spouse Employer Address

Position and Job Description

Reason for Leaving (if not currently employed)

Do You Have a Social Worker?

Social Worker

Agency

Social Worker Phone

Have You Seen a Financial Planner in the Past 6 Months?

Who

Have You Requested Assistance in the Past 6 Months?

Amount Recieved?

Friends / Family Contacted

Church / Agencies Contacted

What Steps Are You Taking to Improve Your Situation?

Are You a Member of The Gate?

Do You Regularly Attend Church?

What is the Name of the Church You Attend?

How Long?

How Frequently?

Are You a Member?

Who Suggested You Contact The Gate?

Relationship

Have You Previously Received Help from The Gate?

Phone

When / What?

References
Name - Phone - Relationship