Benevolence Form

The purpose of RBC's Benevolence Fund is to minister to individuals or families during a time of hardship or crisis by assisting them with their basic needs, such as necessary utilities and food.

To apply for assistance from RBC, please work through and answer these questions truthfully and honestly. However, completion of this form does not in any way guarantee that you will receive assistance from RBC. After completion, an elder or deacon of RBC will be in contact with you regarding your submission.

Your name *

Email address *

Phone number *

Address *

Birthdate *

Gender *

Marital status *

Household members

List any members of your household that are currently living with you.

I am a... *

Which of these describes your situation? *

Loss of employment

Death in the family of a wage earner

Costly medical condition

Severe hardship resulting from a natural disaster

Critical injury

Other

Describe in more detail what you are requesting assistance for. *

I am willing to meet with an elder or deacon of RBC to discuss my monetary situation. *

I consent for RBC to follow up with me regarding any of the information that I have provided. *

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