North Shore Bible Church - Application for Financial Assistance

The Applicant is the person completing this form. The Beneficiary is the person who would receive the financial assistance if approved. The Applicant can also be the Beneficiary.

Confidentiality: All information will be kept private to the best of our ability and reviewed only by members of the Charis Steering Committee. Check the box below if you would like this information to be shared with the Board of Elders so that they can be in ongoing prayer over this situation:

Please share my request with the Elders for ongoing prayer.

By submitting this completed form, I am applying for financial assistance:

(A.) For myself (move to Section 2)

(B) On behalf of someone else (the Beneficiary)

First Name

Last Name

Phone Number

Email

Home Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Mailing Address (Optional)

Apartment, suite, etc.

City

State

Zip/Postal Code

Preferred Method of Contact

Phone

Email

Text

Other

Single Choice

Choice One

Choice Two

Choice Three

First Name

Last Name

Phone Number

Your Relationship to the Beneficiary:

Are you a Member and/or Regular Attendee of NSBC? (averages twice per month in person attendance)

Yes

No

Other

Amount of Assistance Requested:

Date Assistance is Required

Briefly describe the Beneficiary’s current situation, reason for this request and if the assistance needed is one time or ongoing:

(Detailed financials are not required, but please share enough to help us understand the financial need.)

Has the Beneficiary received financial assistance from NSBC before?

Yes

No

If yes, when did you receive assistance?

Is the Beneficiary currently employed?

Yes

No

Part-time

Yes, at:

Part-time at:

Does the Beneficiary have any dependents?

Yes

No

Number of dependants

Is the Beneficiary receiving financial or other forms of assistance from any other organization or agency at this time?

Yes

No

Yes, please list:

What additional actions has the Beneficiary taken or plans to take in addressing this situation?

To help verify the Beneficiary’s situation not for character judgment

Please provide one or two personal references who are aware of the Beneficiary’s situation (no financial disclosure required). If you selected B at the top of this form you can also be a reference here:

Reference One:

First Name

Last Name

Phone Number

Email

Reference Two:

First Name

Last Name

Phone Number

Email

I affirm that the information provided is accurate to the best of my knowledge. I understand that submission of this application does not guarantee assistance and that NSBC may follow up with me or my references for additional context.

Signature

Date Input

If you have any questions while completing this application, send an email to [email protected]

Application for Financial Assistance

Service Times

FOLLOW US