APPLICATION FOR ASSISTANCE

Please complete all information below and allow up to one week for processing. Incomplete or missing information will delay our processing/response.

Applicant Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How long at this address?

Please check one

Rent?

Own?

Marital Status

Married

Divorced

Single

Separated

Home Phone

Please provide at least one contact phone number.

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Driver's License Number

Please list names, ages, and relationship of all individuals living at this address:

What church do you attend?

Do you regularly tithe on your income?

If so, where do you give your tithe?

Current Employer & how long employed?

Previous Employer & how long employed?

Spouse's Employer & how long employed?

If unemployed, how long and reason for unemployment?

How are you seeking employment?

What are the circumstances that led to this request for assistance?

Please list what you are asking the church to pay. Copies of the bills must be sent via email to info@destinyokc.com. ALL PAYMENTS ARE MADE DIRECTLY TO THE SPECIFIC VENDOR

INCLUDE COMPANY NAME, ACCOUNT NUMBER, AMOUNT NEEDED & DUE DATE

How will you meet these needs in the future?

Have you asked for assistance from our church before?

If YES, what was the request and when?

Are you related to any church staff, board member or key contributor?

Please provide two references who can validate this information:

INCLUDE NAME, PHONE NUMBER, AND RELATIONSHIP

Please provide information on your current monthly income sources and all expenses by type (you may email us a list/spreadsheet or list information here):

INCOME: include your job, spouse's job, Social Security, SSI/Disability, Food Stamps or any other sources of income. EXPENSES: include tithes and offerings, rent/mortgage, car payment(s), auto insurance, auto gas & oil, electric, gas, water, food, cable tv, daycare, internet, child support, credit card payment(s), school loan payment(s), other loan payment(s), or any other monthly expenses

I CERTIFY ALL INFORMATION IS ACCURATE AND I AUTHORIZE DESTINY CHRISTIAN CENTER TO VERIFY ALL INFORMATION PROVIDED.

APPLICATION FOR ASSISTANCE

Time

Location

CONTACT

Church online