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Stories from Washington County
Ministerial Alliance
Hosted by
Select area churches
Contact Info
Name
Phone
Rick Posey – Potosi Southern Baptist
573.438.2276
MAB Application
Date of Application
*
MM slash DD slash YYYY
What is the Benevolence Fund?
The Benevolence Fund is a limited financial fund, made available by application to anyone struggling financially due to unforeseen circumstances. The money is granted as a gift, and repayment is not expected. However, if you are blessed in the future and would like to help someone else, you may repay the gift. It will be used to help someone else in need. Your request will be reviewed and you will be contacted if more information is needed. A failure to provide requested information will forfeit your eligibility for benevolence. Upon a decision you will be notified by telephone. If your request is approved, it may take up to two weeks to receive funding. You are only eligible to receive assistance once every six months. The decision made by the Ministerial Alliance or its representatives regarding financial assistance is final and there is no appeal.
What kind of help is available?
Our concern for you is not limited to your financial situation. We care about your emotional, spiritual, and relational health, as well as your general well being. Would you like a Pastor to follow up with you about these types of concerns?
(Note: your response to this has no bearing on the decision about your financial request).
*
No thank you.
Yes.
Please contact me at this phone number:
Our response to your request may include:
Referral for spiritual, financial, and/or general counseling
Limited financial support
Food bank referrals
Other social service referrals
A. Personal Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Daytime Phone
*
Evening Phone
*
Gender
*
Male
Female
Date of Birth
*
MM slash DD slash YYYY
Age
*
Marital Status
*
Single
Married
Separated
Divorced
Widowed
Other
Name and location of church you belong:
If you do not belong to a church, briefly explain why.
B. Household Information:
Full Name
Age
Relationship to You
Monthly Income
Full Name
Age
Relationship to You
Monthly Income
Full Name
Age
Relationship to You
Monthly Income
Full Name
Age
Relationship to You
Monthly Income
Full Name
Age
Relationship to You
Monthly Income
C. Please list your specific requests:
Amount
*
Description of Need
*
Date
MM slash DD slash YYYY
Amount
Description of Need
Date
MM slash DD slash YYYY
D. Briefly, what events led to you needing assistance?
Description
*
E. Applicant Employment History:
Present/Most Recent Employer:
Employer Number:
If unemployed, please provide a reason:
Are you currently seeking employment:
Yes
No
If “No” why not?
What steps are you taking to seek active employment?
F. Additional Information
Have you contacted anyone else for assistance within the last six months?
*
Yes
No
Please specify:
Family
Friends
Churches
Agencies
Are any of the above assisting with your need?
Yes
No
If "Yes," amount?
If “No,” why not?
Are you receiving financial aid from a government agency?
*
Yes
No
Amount:
Please Specify:
Unemployment Insurance
Social Security
Workers Compensation
Disability
Other
Please Specify:
Do you have and use a budget?
*
Yes
No
What steps are you taking to improve your present situation?
*
Have you requested or received assistance from the Ministerial Alliance before?
*
Yes
No
If “Yes,” when did you make the request?
MM slash DD slash YYYY
Amount:
G. References:
Name
*
Relationship
*
Phone
*
Name
*
Relationship
*
Phone
*
Name
*
Relationship
*
Phone
*
H. Authorization
By signing below, you are giving permission to have the appropriate church personnel validate any of the above information.
CAPTCHA
Additional Information
Services:
Community fellowship, aid with utility/ rental & medical assistance
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