Guidelines for disbursement of Benevolence Funds: (Please read and initial after each guideline)

Transcription

1 Guidelines for disbursement of Benevolence Funds: (Please read and initial after each guideline) 1. All requests for financial aid from the Benevolence Fund will be submitted and initially evaluated by the Benevolence Committee. The process takes approximately 3 weeks upon receipt of a completed request form. Initials 2. All requests will be evaluated and determined by the Benevolence Committee provided financial aid is to meet basic necessities (food, immediate lodging, clothing or urgent medical). Whenever possible, checks will be written directly to a provider (i.e. landlord, utility companies, etc.) rather than the individual requesting assistance. Initials 3. Financial aid is seen as a one- time gift. A recipient may not receive aid on a regular basis. There may be extraordinary circumstances where a recipient receives a gift for a second time (what qualifies as extraordinary circumstances will be determined by the benevolence committee). Initials 4. Financial aid is a gift not a loan. A recipient is not obligated to return or pay back any financial assistance provided. A recipient may give money to the Benevolence Fund at some later date if he/she desires. Initials 5. A potential recipient must first go to family members for financial aid before he/she will be considered for benevolence assistance. If a potential recipient will not go to family members for financial support, there must be an adequate reason. Initials 6. Benevolence assistance is for people within the The Garden Church body. A potential recipient must be involved in a Garden program on a regular basis (a minimum of six months). Testimony of other members in the church, a local permanent address or records of involvement in a church program may be used to check involvement. Initials 7. Potential recipients must be willing to receive counseling (financial, family, emotional, etc.) if the Benevolence Committee determines that a personal problem is involved in the financial crisis. Initials 8. The Benevolence Committee has the right to refuse financial aid to anyone who, in their estimations, will have negative or irresponsible behavior reinforced by a financial gift. Initials 9. If for any of the above reasons a person does not qualify for financial aid, members of the Benevolence Team may assist him/her in going to the right organizations for financial aid (welfare, etc.) and will help meet his/her spiritual or emotional needs. Initials 10. Upon completion, please return form for processing to: The Garden Church: First Fruits PO Box Long Beach, CA or to Contact: info@thegardenlb.org OFFICE USE ONLY:: Submission: Contact: Team review: Informed family:

2 PERSONAL INFORMATION *All areas must be completed for consideration Date Last Name First Name Address Apt. # City State Zip Phone (day) (eve) best time/way to reach me is Male Female Date of Birth (MM/DD/YY) Age REQUEST Who referred you to benevolence? Name: Total amount requested (please put an amount)$ Date needed by: Please state a brief summary of your need. What are the circumstances which have resulted in your need for assistance? Please be specific. Itemized Expenses for Consideration (Please put in order of importance) Type of Expense/Description Amount Due On Payable To Example :: rent /14/09 Apartment Complex

3 FAMILY Marital Status: Single r Married r Separated r Divorced r Widowed r Spouses Name: Male r Female r Age: Children s Names (Print name, indicate sex, birth date, age and indicate if they re living at home with you) Name Male r Female r Name Male r Female r Name Male r Female r Name Male r Female r DOB Age: DOB Age: DOB Age: DOB Age: CHRISTIAN BACKGROUND Do you regularly attend The Garden Church celebration services? Yes r No r What service? How long have you attended The Garden Church? Please list the groups and/or programs you are involved with: Leader and/or pastor s name: Do you regularly attend a Community Group or other group at The Garden? Yes r No r For how long? Do you also attend another church? Yes r No r Which one? Are you a Christian? Yes r No r Briefly describe how you came to know Christ as your Savior:

4 REFERENCES (Please list three individuals that attend The Garden Church who know you well. Notify References that a Benevolence team member will be contacting them). Name: Relationship to applicant: Phone Length of time known: Name: Relationship to applicant: Phone Length of time known: Name: Relationship to applicant: Phone Length of time known: **references will be contacted by a member of the benevolence committee and asked specific questions regarding their relationship with the applicant** ASSISTANCE Have you previously applied for benevolence? Yes r No r When? Have you contacted your family members regarding your need? Yes r No r Are they able/willing to help? Yes r No r If no, why not? Have you or are you currently attending: Financial Seminar r Recovery Ministries r Have you made a request for help from any other party/group? Yes r No r If yes, who? Counseling with? EDUCATION High School: r 12 r 11 r 10 r 9 r GED College Attended: Major: Graduate? Yes r No r Degree: Trade or Business School: Graduate? Yes r No r

5 EMPLOYMENT HISTORY (Please do not substitute a resume for this section) Former/Present employer: address city state zip Employment dates: Reason for leaving: thru Former/Present employer: address city state zip Employment dates: Reason for leaving: thru Former/Present employer: address city state zip Employment dates: Reason for leaving: thru Former/Present employer: address city state zip Employment dates: Reason for leaving: thru

6 WHAT I OWN Cash on hand $ Checking Accounts $ Savings Accounts $ Money Market Funds $ CD s $ Mutual Funds $ Insurance (cash value) $ Home value $ IRA / 401K $ Stocks $ Bonds $ Car info: year/make/model WHAT I OWE Loan Balance Home Mortgage $ $ Home Equity Loan $ $ Other Property Mortgage $ $ American Express $ $ Visa $ $ Visa $ $ Master Card $ $ Master Card $ $ Department Stores $ $ Gas Card $ $ Gas Card $ $ Car Loan $ $ Car Loan $ $ Bank Loan $ $ Finance Company $ $ Relative/Friend $ $ Furniture $ $ School Loans $ $ IRS Debt $ $ Payment

7 INCOME Income #1: $ (after taxes) Paid: r weekly r bi- monthly r monthly Income #2: $ (after taxes) Paid: r weekly r bi- monthly r monthly Income #3: $ (after taxes) Paid: r weekly r bi- monthly r monthly Income #4: $ (after taxes) Paid: r weekly r bi- monthly r monthly OTHER INCOME SOURCES Unemployment $ Paid: r weekly r bi- monthly r monthly Child support $ Paid: r weekly r bi- monthly r monthly Disability $ Paid: r weekly r bi- monthly r monthly Public aid $ Paid: r weekly r bi- monthly r monthly Alimony $ Paid: r weekly r bi- monthly r monthly Food stamps $ Paid: r weekly r bi- monthly r monthly Dividends $ Paid: r weekly r monthly r yearly TOTAL MONTHLY INCOME FROM ALL SOURCES: $ (A) WHAT I SPEND Housing (monthly average) Mortgage $ Taxes $ Insurance $ Maintenance $ Association dues $ Rent $ Insurance $ Electric $ Gas $ Water $ Telephone $ Total (b) $ (b) Auto/Transportation(monthly average) Insurance r None $ Registration $ Bus/Parking $ Gas $ Maintenance $ Total (c) $ Professional Services (monthly) Child Care $ Medical/Dental $ Prescriptions $ Legal $ Counseling $ Union/Prof. Dues $ Total (d) $ per yr. (c) (d)

8 WHAT I SPEND (cont d) Insurance (monthly) (check yes if paid by employer. list amount if you make payment) Life Insurance r yes $ Medical r yes $ Dental r yes $ Disability r yes $ Home Owners r yes $ Total (e) $ Loan Payments (monthly) Car Payment #1 $ Car Payment #2 $ Visa #1 $ Visa #2 $ Master Card $ Discover $ American Express $ Gas Cards $ Department Stores $ School Loans $ Bank Loans $ Credit Union $ Home Equity Loan $ Total (f) $ (e) (f) Household/Personal (monthly) Food/liquor/cigarettes $ Beauty/cosmetics $ Laundry/cleaning $ Books/magazines $ Gifts $ Education $ Clothing $ Allowances/lessons $ Child support payments $ Total (h) $ Entertainment (monthly) Dining Out $ Lunches/Snacks $ Movies/Events $ Babysitting $ Vacation/Trips $ Lottery/Gambling $ Cable TV $ Health Club $ Total (i) $ (h) (i) Giving (monthly) Tithe $ Total (g) $ (g) TOTAL MONTHLY EXPENSES add totals from lines (b) thru (i) $ (J) INCOME total monthly income from all sources: $ (A) EXPENSES total monthly expenses: $ (J) BALANCE income minus expenses: $ (A minus J)

9 MY/OUR AGREEMENT WITH The Garden I (we) have read and understand the policy of The Garden Church Benevolence Fund. I (we) am (are) willing to accept financial aid as a gift, and understand that repayment is not necessary or expected. I (we) also am (are) willing to accept the recommendations of the committee to enter counseling (financial or emotional) if it is necessary. I (we) understand that the committee will contact my personal references, any person listed on this application, and may verify any information as part of determining whether or not The Garden Church will meet my (our) need. I (we) also agree to allow The Garden Church benevolence committee to obtain a copy of my credit report at their sole discretion. I (we) understand that The Garden Church Benevolence Ministry staff and/or volunteers will attempt to assist me (us) in developing a plan, and that they do not make any representations or warranties with respect to the results of their services and/or referrals or their ability to help me (us) with my (our) credit/financial/emotional needs. I (we) further agree to indemnify and hold harmless all staff and/or volunteers of The Garden Church, and its employees, agents, counselors, consultants, officers, and directors from any claim, suit, action, demand, or liability of any kind and any nature arising out of or in any manner connected with my (our) participation in these services. I (we) hereby certify that the answers and other information on this application are true and correct and that I (we) understand any misrepresentation or omission of facts on my (our) part will disqualify me (us) from this ministry s service. Applicant: signature date please print name Spouse: (if married, spouse s signature is required) spouse s signature date please print name