Financial Assistance Request Form

Assistance is intended to be used when the individual or family has explored all other options from appropriate sources (i.e., family, savings, and local organizations such as Bluffton Self Help, Beaufort-Jasper Economic Opportunity Commission, and Family Promise who exist to provide support and assistance to those in need as their primary focus).

Preference regarding Financial Assistance will be given to Members and Regular Attendees. Other requests will be considered as opportunity allows.

Galatians 6:9-10 “Let us not lose heart in doing good, for in due time we will reap if we do not grow weary. So then, while we have opportunity, let us do good to all people, and especially to those who are of the household of the faith.”

Name

This address will receive a confirmation email

Phone

Address

Date of Birth

Marital Status

Do you currently attend a church?

Yes No

If yes, where do you attend church?

If you do attend another church, have you requested their assistance? What has been their response?

Who referred you to our church for assistance?

Please list the names and ages of the people residing with you or in your care:

Information about your work and income:

Are you currently employed:

Yes No

Monthly Household Income (including all members of the household):

Employer (or past employer) and phone number:

Date of last employment:

Are you seeking employment?

Yes No Currently Employed

What other agencies have you applied to for help?

Are you receiving financial assistance?

Yes No

If yes, from what source(s):

Discrete bill(s): utilities (water, sewer, electric, and gas) are given preference; others are considered.

We will NOT consider payment (or partial payment) of fines/penalties, child-support, credit cards, TV cable, cell-phone service, storage rental, or hotel stay.

We typically won’t consider partial payment of rent unless there are extenuating circumstances and there is proof of ability to “pay in full” the remainder.

What bill to you need assistance with?

Bill Amount:

Amount of funds available toward this bill:

Amount Requested:

Please explain your need and the circumstances surrounding your situation.

How do you plan to pay this and other bills next month?

Upload supporting documentation such as a lease agreement, utility bill, etc. If approved, disbursement will be made directly to the service provider by check.

Upload (8MB)

I understand that financial assistance from Cornerstone Church Bluffton is a one-time gift. Please understand that based on your information and our evaluation, sometimes the answer may be "no".

I affirm that all the information provided is true and correct to the best of my knowledge.

Yes

Please upload a photo id (such as a driver's license or state id)

Upload (8MB)

My electronic signature:

Only 1 financial assistance approval for non-Members and non-Attendees.

Only 1 financial assistance approval in any 12 month cycle for Members and Regular Attendees, unless there are extenuating circumstances. A second request will NOT be accepted from anyone without a Christian based financial counseling session prior to the approval, regardless of time interval between requests. Maximum cumulative benefits will be on a case by case basis.

Please expect one week to evaluate and process this request. Evaluation may require an in-person appointment.

Financial Assistance Request Form

Description

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