Ministerial Alliance Hosted by Select area churches Contact Info Name Phone Kevin Smith (573) 210-8273 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 InformationName* 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 NeedDate 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 InformationHave 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. AuthorizationBy 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 Tyler Hulsey2021-03-11T12:38:11-06:00
