Financial Assistance Request

GENERAL INFORMATION

Date

Name

This address will receive a confirmation email

Phone

Address

ANSWER BELOW

Do you regularly attend Serenity Church?

Do you have a personal relationship with Jesus Christ?

Are you a member of a different church?

Have you attended any 12-Step meetings?

HOUSEHOLD INFORMATION

Employer's Name

Time with Employer

Monthly Income

Spouse/Partner Name

Spouse/Partner Employed

Spouse/Partner Income

Provide names and ages in household

REQUESTED HELP

Help Requested

Total Amount

Briefly explain your needs and what led to your request

Description

Please fill out this form and click submit.

Someone from Serenity Church will contact you soon.

NOTE: Under Serenity Church's benevolence policy, direct cash payments to individuals are not allowed.

Financial Assistance Request

Description

Please Fix the Following