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Family Worship at Home
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Date of Request
Spouse (if married) (N/A if Single):
If Urgent, Date Needed:
How long have you lived at your current address?
Apt # (or type N/A)
Phone Number (Cell or Home):
Names & Ages of Everyone Living in Your Home:
Advance Community Church Status:
Your Local Church (N/A if None):
How long have you attended this church?
What ministry have you been involved in?
Present Employer (If Unemployed, list last date employed):
Suite # (N/A if None)
Employer Phone Number
If Unemployed, list the last three places you have applied for work and the dates:
Amount Requested: $
Reason(s) you are in need of assistance:
Assistance to be used for (i.e. food, utilities, etc):
Do you have a household budget?
If Yes, do you consistently follow the budget?
Please list other sources of assistance that you have sought (parents, family, other church, loans, sale of property, social programs, consumer credit counseling agency, creditors, etc.)
Are you willing to receive financial counseling?
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