"*" indicates required fields Financial Assistance Request Policies First, we want you to know that you are very important to God and very important to us. We understand that there are some times in life when emergency situations arise that may require some financial assistance in order to remedy. We are thankful that God has allowed us to be a part of aiding in certain financial situations and we pray that any help that may be provided would be a great blessing to you. We strive to be wise in the disbursement of church funds and to be good stewards of that which the Lord has entrusted us to distribute. With that said, please review these policies we have in place that help us to provide assistance to others as well. 1. The primary purpose for financial assistance is to remedy/assist in emergency situations, not ongoing financial needs. Our assistance program is not intended to supplement your income. This helps us ensure that we are able to assist others as well that are experiencing similar situations. If you are in need of ongoing assistance, we would be happy to provide you with a list of local resources to contact for possible assistance. 2. Funds will be distributed mainly to the following emergency situations, rent/mortgage assistance, utility assistance, medical assistance, urgent car repair, and food assistance. Other requests for financial will likely not fall into our ability to assist you financially. 3. Disbursement of funds is at the sole digression of the benevolence committee and reserves the right to deny requests. 4. Our benevolence funds are to be distributed in accordance with I.R.S. regulations for non-profit organizations. 5. Current and active BridgeWay Church members will be given priority in the disbursement of funds. 6. If there is a second request made for financial assistance, you may be asked to attend a budget meeting with an approved budget counselor prior to or after the disbursement of funds. 7. BridgeWay Church will not disperse cash to individuals. In almost all cases, assistance will be dispersed via check made payable directly to the company. (eg. Landlord, public service, hospital, etc.) 8. Please note that we may desire to contact those to whom a debt is owed in order to discuss the dynamics of your situation. We ask that you provide valid and up to date information in order for us to so. Please know, discretion, sensitivity, and tact will be used at all times when interacting with those we may contact about your situation. 9. The benevolence committee will keep your situation in confidence and specifics will only be shared with authorized personnel. Please fill out this form with as much detail as possble. All information will be kept confidential.Personal InformationName* First Last Birth Date* MM slash DD slash YYYY Social Security Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Enter Email Confirm Email Phone*Immediate Need(s)* Food Shelter Rent/Mortgage Utilities Transient Medical Emergencies Other Please explain other* What is your marital status?* Single Married Separated Widowed Your Current Employer* Spouse's Employer* Children's Ages Medical EmergenciesYou are requesting payment of emergency medical bills, please supply the following informationMedical Emergency List*If there are multiple needs, please click on the + at the end of the row.Company NamePhoneContact PersonAddressCityStateZipAccount #Amount DueAmount Required Add RemoveRent/MortgageYou are requesting payment of rent/mortgage bills, please supply the following information.Rent/Mortgage List*If there are multiple needs, please click on the + at the end of the row.Company NamePhoneContact PersonAddressCityStateZipAccount #Amount DueAmount Required Add RemoveBill Payment ListYou are requesting payment of misc bills, please supply the following information.Bills List*If there are multiple needs, please click on the + at the end of the row.Company NamePhoneContact PersonAddressCityStateZipAccount #Amount DueAmount Required Add RemoveFinancial HistoryWhat is your monthly income?*List of current financial obligations.*Enter your average monthly costs in $$Rent/MortgageAutoElectricGas/OilWaterPhoneMedicalCell PhoneOther Add RemoveDocumentation Upload*Please upload an documentation you have for the financial request you have. You can upload a pdf, jpg or png file. Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 256 MB. Are you a currently a member of BridgeWay?* Yes No How long have you been a member?* Signature Type*I have read the policies listed above and agree to allow BridgeWay Church to contact the needed people in order to gain information relevant to this request. Type your name Sign with finger Signature* Reset signature Signature locked. Reset to sign again Type your Name*