Event Information | Parkway Fellowship

Personal Information

First Name

Last Name

Address

Date of Birth

/ /

Email

Mobile Phone Number

Church Information

Which location do you attend?

Do you currently attend Parkway Fellowship regularly? (at least 1x a month)

Yes No

What Small Group are you connected to?

Are you tithing?

Yes No

Do you give regularly to Parkway?

Yes No

Family Information

Employment Information

Are you presently employed?

Yes No

What was your Job Title?

Income Information

Please indicate the source and amount received per month

Employment (1)

$

SNAP/TANF

$

Food Stamps

$

Employment (2)

$

Disability

$

HUD Housing

$

Unemployment

$

SSI

$

Child Support

$

Need Request

Please state the cause or nature of your current hardship:

What steps are you taking to remedy this situation:

Have you sought help from any other churches or social agencies?

Yes No

Type of assistance requested (Bill/Statement must be attached)

Mortgage/Rent Company

Amount Requesting

$

Utility - Electricity Company

Amount Requesting

$

Utility - Gas Company

Amount Requesting

$

Utility - Water Company

Amount Requesting

$

Automobile Payment Company

Amount Requesting

$

Automobile Repairs Company

Amount Requesting

$

Auto Other (Bus Pass) Company

Amount Requesting

$

Childcare Company

Amount Requesting

$

Please attach copies of Monthly Expenses & Statements/Bills for which you are requesting assistance

Upload

Authorization/Acknowledgement

This benevolence form is not a contract for assistance, nor is it a guarantee of assistance from Parkway Fellowship. Your authorization/acknowledgement below indicates that you understand the following: You may be referred to outside/appropriate agencies (Unemployment Office, Welfare Department, etc.) Parkway Fellowship reserves the right to follow up on any information provided in the application. The Pastoral staff member will be sensitive to confidential information Parkway Fellowship will hold you accountable for taking steps to remedy this situation Assistance is intended to be a gift. Under no circumstances is a gift from Parkway Fellowship to be considered a loan. No gift may be repaid, either in part or in full, in money or labor

By checking this box you authorize and acknowledge the statement above

Parkway Fellowship Benevolence Form

Form Entry

Personal Information

Church Information

Family Information

Employment Information

Income Information

Need Request

Type of assistance requested (Bill/Statement must be attached)

Authorization/Acknowledgement