Vive Cares - Benevolence Request Form

Name

This address will receive a confirmation email

Phone

Address

Marital Status

Single Engaged Married Separated Divorced Widowed

Do you have any children living with you?

No, I do not have children that live with me. Yes, I have 1-2 children living with me. Yes, I have 3-4 children living with me. Yes, I have 5 or more children living with me.

What is your employment status?

Employed Unemployed

Which best describes your attendance and involvement at Vive? Please select all that apply.

Regular Attender Occasional Attender Moment Maker Active in a Life Group Non-Attender

Have you previously received financial assistance from Vive City Chapel?

Yes No

What type of assistance is needed?

Food: Groceries Housing: Rent/Mortgage Utilities: Electricity, Water, etc. Transportation: Gas

What is the requested amount of financial assistance needed?

Please provide a brief explanation of your need.

What steps have you taken to assist yourself with your circumstances and improve your financial situation?

Qualified Assistance Policy

The Vive Cares Benevolence Fund is intended for emergency shelter needs.

1. Emergency shelter needs include food, electricity, gas, water or rent/mortgage assistance. Telephone or cell phone bills, car payments, rent deposits, legal fees, and cable bills are not considered emergency shelter needs.

2. Required: Copies of past due bills as evidence of an emergency situation

3. Required: Paystubs from two most recent pay periods

4. Required: Copy of photo ID for applicant and spouse, if married

5. Required: Copies of bank statements. Please provide two full statements showing daily activity. If you don’t have a bank account, we will accept a daily spending log for the past two weeks.

6. Checks will be made payable to the vendor/creditor (and not to the applicant).

7. NO cash gifts will be given as financial assistance.

Check the box below indicating your understanding of our Qualified Assistance Policy.

Yes, I understand.

Application Review

Supplying documentation is critical in helping us determine the best way to help and support your situation. Not providing paperwork will delay the process. Let us know if there are any issues or questions.

You may upload up to 5 files below. If you need to submit more files, please email us at finance@vivecitychapel.org.

You will receive notification either of an answer or a next step to be taken. Please be assured that we will prayerfully consider your request and respond accordingly.