MONTHLY INCOME:
*If one of the following doesn't apply to you, fill in the space with n/a.
NOTE: OUR CHURCH IS NOT A GOVERMENT ASSISTED AGENCY. ALL RESOURCES ARE A RESULT OF DIRECT DONATIONS OF OUR CONGREGATION.
Name 2 people who are not family members that can confrim this need:
The above information is true to the best of my knowledge, and I authorize the release of any information necessary to verify statements given on this application. I realize that any deliberate misrepresentation (dishonesty) of these circumstances, when discovered, will void my application for assistance.
** IMPORTANT** PLEASE SUBMIT A PICTURE OF YOU PHOTO ID AND ANY BILLS OR PAPER WORK RELATED TO THIS REQUEST TO: forcoffee@gracepointechurch.org (We must have this information to consider and process your request.)