Benevolence Request

The purpose of Benevolence at Ecclesia is to provide a measure of relief for those in crisis by inviting them into community and connecting them to a variety of available resources, which may include financial assistance.

Ineligible Requests include:
- Credit Card Debt
- Automobile Purchase
- Long Term or Recurring Expenses
- Cash

Please fill out this application so that we may learn more about you and your needs.

Please allow at least 3-4 business (M-F) days for your application to be reviewed.

If you are filling out this form for someone else, please complete the form with the requestors information.

Your name *

Email address *

Connection to Ecclesia

Do you attend Ecclesia? *

If selected 'Yes' please select your campus below.

Primary Campus

Personal Information

Address

Phone Number

Birthday

Gender

Tell us about your need

Amount Requested *

Date Needed *

Description of your request *

Please describe your current situation and the assistance you need. Please provide all relevant details, including when this need started.

Is there another way this need Can be met? If so, please explain.

Are there other organizations or individuals you have approached to help meet this need?

Apart from providing financial aid, how can our community help you?

How can our community support you after this need is met?

Additional Information

Family Information

If you're married, have children, have any extended family in the Houston area, your household size, etc.

Are you currently employed? *

Employer

Employer Phone Number

If you are submitting this application on someone's behalf, please complete the fields below.

Name

Phone

Acknowledgement and digital consent

By selecting the checkbox below and completing this form, I acknowledge and agree to the following statements:

- If requested, I will provide documentation regarding my income, expenses, and/or bank accounts.
- I authorize Ecclesia to review and share information in this document or otherwise provided as necessary for the purpose of evaluating my request for assistance.
- I promise to notify Ecclesia of any funds or help I receive from another source regarding this request.
- I promise to use any type of aid I receive from Ecclesia in connection with my request for assistance solely for the purposes I have described in this document.
- I understand that Ecclesia has the right at any time, and in its sole discretion, to deny a request for assistance, to provide non financial assistance rather than financial aid, and to change or terminate any type of aid it chooses to provide.
- I understand that Ecclesia does not discriminate on the basis of race, color, sex, national origin, age, disability, relationship with anyone in the leadership of Ecclesia, or financial contributions to Ecclesia.

By Selecting the box below you agree to the conditions of participation listed above. *

I accept

Phone number

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