Home
Sermons
Archive
Live Stream
NBFM
Leadership & Meetings
Calendar
Contact Us
NBFM Bylaws
NBFM Assistance Application
Menu
Home
Sermons
Archive
Live Stream
NBFM
Leadership & Meetings
Calendar
Contact Us
NBFM Bylaws
NBFM Assistance Application
Facebook-square
GIVE
ASSISTANCE APPLICATION
Please fill out the form below, or print the application with the link.
Download Application
Name
Date
Emergency Contact
Physical Address
Phone
Email
Can You pass a drug test?
YES
NO
If no, please explain why You cannot pass a drug test.
Warrents or Pending Charges?
What are your immediate needs? Please check all that apply.
Substance Abuse Recovery
Safe Shelter
Food
Financial Assistance
Clothes
Counseling
Other
Explain Other...
Marital Status
Single
Married
Divorced
Seperated
Widowed
Name and location of home church
Name of Pastor
Pastor's Phone Number
Current or most recent Employer information. (You and Your spouse.)
If currently employed please select
You
Spouse
If not, why?
Name of company or business
Phone
Contact Person
Name of company or business ( SPOUSE )
Phone ( SPOUSE )
Contact Person ( SPOUSE )
What is your source of income?
Income frequency
Weekly
Bi-Weekly
Monthly
How many are in the house?
Children’s name & ages of only those who are currently living with you on daily basis
Briefly explain the circumstances which brought about this need:
Check what type of financial aid you may be receiving for a government agency:
Unemployment Insurance
Social Security
Worker’s Compensation
Disability
Other
Are you willing to meet with a Benevolent committee who may ask other and personal questions?
Yes
No
Do you know where the church income comes from to operate?
Yes
No
Please explain your understanding.
Would you be willing to work with a financial budget counselor
Yes
No
All of the above information as well as any information from gathered from a budget counselor or a Benevolent committee will remain confidential except for those in the decision making process.
I give my permission to have the appropriate church personnel validate any of the above information.
Send
MUST PASS DRUG TEST TO RECEIVE ASSISTANCE