Benevolence Application

West Ridge Church wants to help those who are a part of our local congregation and live in our community when they fall on difficult circumstances. Fill out this form to be considered for financial assistance.

PEOPLE WHO DO NOT LIVE IN THE GREATER EAU CLAIRE, WI AREA WILL NOT BE CONSIDERED FOR ASSISTANCE

Your name *

Email address *

Personal & Household Information

Address

Phone number

Birthdate

Gender

Marital status

Household members

Please list all household members (spouse, children, adults who live with you).

Request for Assistance

Please share with us your specific need. We do not issue checks to you personally, but will issue a check payment directly to the company/landlord on your behalf. If you do not provide this information there will be a delay in processing your request.

What do you need help paying for/purchasing? *

How much is the bill/cost? *

min: 0 / max: 1000

When do you need it by? *

If your request is for a bill such as electric, gas, or housing payment, what is the name of the business and the address where bills can be sent? *

What events led to your need for assistance? *

Employment Information

Are you currently employeed? *

Yes

Is anyone else in your household employed? If yes list name of the person and workplace. *

Housing Information

Do you currently own or rent?

How long have you lived at your current address?

Household Finances

What is your household's total monthly income? *

Include wages from employment for all members of your household, child support, retirement, Social Security, SSI/Disability, SNAP, ect.

What are you household's total monthly expenses? *

Include payments for essential expenses such as: Rent/Mortgage, Car payment, Insurance (auto, home, medical), Auto gas, Utilities (electric, gas, water, trash), Internet, Phone, Debt payments (credit cards, student loans), Childcare, Child support, Food

Additional Information

Please list any physical or emotional issues that hinder you from meeting your financial needs.

Do you struggle with addiction? *

Have you contacted anyone else for assistance within the last six months?

Check all that apply

Family

Friends

Churches

Agencies (Social Worker, Food Bank, ADRC, Community Action Agency)

Church Involvement

How would you describe your current relationship with Jesus Christ? *

On average, how often do you attend church services *

Do you attend West Ridge Church? *

Eau Claire, WI

Who suggested that you contact West Ridge Church? *

What is your relationship to the person that referred you?

References

Reference 1 *

Please provide the name, phone number, relationship, and how many years you have been acquainted of a personal or work reference.

Reference 2 *

Please provide the name, phone number, relationship, and how many years you have been acquainted of a personal or work reference.

Reference 3 *

Please provide the name, phone number, relationship, and how many years you have been acquainted of a personal or work reference.

Benevolence Policy Guidelines

• We will treat you with dignity and respect throughout the process. Therefore, abuse or aggressive language or actions will not be tolerated.
• We care about your spiritual and emotional needs and will talk to you about Jesus, connect you with other agencies for counseling, and pray for you.
• We want to empower you to get out of a hole and back on track. As we consider your application, we will discern if granting the stated request will help you gain stability for the future.
• Each application will be considered based on the necessity of the item/bill, if you are using what funds you have wisely, and circumstances that have contributed to you asking for help.
• We will not give cash and do not have cash on hand. To make sure the funds go to the stated need, we will pay a business directly on your behalf or purchase a specific use gift card.
• God has entrusted the church with the tithes of his people, and we are responsible for using funds wisely. Because of limited funds and the great need in our community, we will only help a family once per year, except in extreme circumstances.
• Each application will be assessed prayerfully and practically through an interview and checking of references.

Policy Acknowledgement and Authorization

I agree to the terms of the Benevolence Policy as stated above. *

I understand that this application is not a contract for assistance and that submitting this application does not guarantee I will receive assistance. I understand that it will take at least one week to process my application. *

I authorize West Ridge Church to verify all information provided in this application. *

Digital Signature *

Type your name to act as your signature