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BENEVOLENCE APPLICATION
Please complete the form below and someone will contact you!
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Spouse's Name
*
First
Last
Email
*
Cell Phone
*
Phone Number
*
Do you have children at home?
*
Yes
No
How Many Children?
*
0
1
2
3
4
5
6
7
Assistance Requested For:
*
Utilities
Rent
Mortgage
How much are you able to contribute?
*
Have You Attempted To Call and Make Payment Arrangements
*
Yes
No
If No please do so before completing this form. If yes, please explain the outcome
*
Amount of Bill
*
Amount Received from Other Agencies
*
Upload a Copy of Bill
*
Max file size: 20MB
We must have a copy of the bill before this request can be processed
Nature or Emergency
*
Foreclosure
Eviction
Disconnection
Describe the events that led to your present circumstance
*
Agency Name
*
Account Number
*
Agency Phone
*
Agency P.O.C.
*
Current Place of Employment
*
How Long
*
Occupation
*
Total Monthly Income (spouse income included)
*
Include child support, alimony, disability, social security, etc.
Are You a Member of Kingdom Empowerment?
*
Yes
No
If No, do you attend on a regular basis?
*
Yes
No
Are You a Tither?
*
Yes
No
My initials below indicates all information provided is true and accurate to the best of my knowledge. I understand that my request will be denied if I have knowingly submitted false information. I also understand that I should continue to seek assistance form other resources because completing this form does not guarantee assistance will be provided
Submit Request
HOME
KNOW JESUS
PRAYER
OUR PASTORS
WATCH
>
KINGDOM NATION
BABY DEDICATION
BENEVLOENCE
MINISTRY ENGAGEMENT
ABOUT US
MISSION AND VISION
WHAT WE BELIEVE
COMING UP
MONEY CLINIC
Water Baptism
PARTNERSHIP
SERVE
PARTNERSHIP UPDATE
KE GEAR
GIVING
Gift Card Drive