RbC Benevolence Form

Full Name *Enter your full name.

Enter your email *

Date Select the date.

Are you a church member? If not, how were you referred to us? *

What is your need? (Please be specific.) *

Where do your closest relatives live? *

Do they know about your need? *

Are you receiving any aid (financially, or otherwise) from a government agency (unemployment insurance, Social Security, worker’s compensation)? *

Have you been employed locally? Where? *

When and where was the last time you sought employment? *

Are you willing to work today if we know of an available job? *

Do you attend church? If so, where? *

What is your minister’s name? *

Have you sought assistance at any other churches in this area? If so, where? *

If we are unable to help you, what other options do you have? *

If we are able to help you, how many people are involved? (Please list family members, etc.) *

Do you have some form of identification? *