Helping Hands Assistance Application

Please Read

This benevolence form is not a contract for assistance, nor is it a guarantee of assistance. We will do the best we can with the resources we have on a case-by-case basis. *You may be asked to signed a hard copy of the application and/or asked questions regarding the answers given.

Personal Information

First Name

Last Name

Phone Number

Birthdate

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Church Information

Do You Currently Attend CTK Hope Church?

Yes

Do You Currently Tithe at CTK Hope Church?

Yes

Other Church Your Connected With?

Yes

Other Church Your Connected With?

Current Employment

Are you currently employed?

Yes

Type of Employment?

Full-Time

Part-Time

N/A

Name of Employer?

Supervisor Name & Title

Work Phone?

What are you Employed to do?

Job Title?

Start Date of Employment?

If not employed, are you...

Unemployed

Retired

Disabled

Other

Elaborate on other?

How long have you been unemployed / retired / disabled?

Previous Employment

Previous Employment #1

Type of Employment?

Full-Time

Part-Time

N/A

Name of Employer?

Supervisor Name & Title

Work Phone?

What are you Employed to do?

Job Title?

Start Date of Employment?

End Date of Employment?

Previous Employment #2

Type of Employment?

Full-Time

Part-Time

N/A

Name of Employer?

Supervisor Name & Title

Work Phone?

What are you Employed to do?

Job Title?

Start Date of Employment?

End Date of Employment?

Income Information

Add monthly income amounts in the following fields below.

Employment #1

Employment #2

Employment #3

Unemployment

AFDC / TANF

Disability

SSI

Food Stamps (FAP)

HUD Housing

Other Income

Notice to Requestor

Following submitting this form you will need to email Monthly Expense Documents, Invoices / Bills regarding this request, and your Bank statement to our Helping Hands Team

I understand in order for this request to be processed I will need to provide documents to helpinghands@ctkhope.net

I Agree and will email documents after submitting this form

This benevolence form is not a contact for assistance, nor is it a guarantee of assistance. Your Signature indicates you understand and agree with the following:

1. Helping Hands Ministry will refer you to outside/appropriate agencies (e.g., Unemployment Office, Welfare Dept., etc.)

2. Helping Hands Ministry reserves the right to follow up on any information provided to the Committee. The Helping Hands Committee will be sensitive to confidential information.

3. Helping Hands Ministry hold you accountable for taking steps to remedy this situation

4. Assistance is intended to be a gift. Under no circumstances is a gift from Helping Hands to be considered a loan. No gift may be repaid in part or in full, in money, or in labor.

Signature

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Helping Hands Assistance Application

Please Read

Personal Information

Church Information

Current Employment

Previous Employment

Previous Employment #1

Previous Employment #2

Income Information

Request Needed

Notice to Requestor

Following submitting this form you will need to email Monthly Expense Documents, Invoices / Bills regarding this request, and your Bank statement to our Helping Hands Team

This benevolence form is not a contact for assistance, nor is it a guarantee of assistance. Your Signature indicates you understand and agree with the following: