8761 Huron Street
Thornton, CO 80260
Phone: 303-828-9300
Email: Office@TreasuringGod.com
www.TreasuringGod.com

BENEVOLENCE APPLICATION

Personal Information: (Please Print):

Name:	
	
Today’s Date:	

Gender:	
Male	
	
Female	
	
Date Of Birth	

Current Address:	
	
City:	
	
State:	
	
Zip:	

Current Residence:	
Rent	
	
Own	
	
Homeless	
	
Live with:	
Family	
	
Friends	

Home Phone:	
	
Cell Phone:	
	
Email:	

Marital Status:	
Single	
	
Married	
	
Divorced	
	
Separated	
	
Widowed	

Names & ages of others in household:	

	

Are you receiving assistance from any other source?  	
No	
	
Yes	
	
If Yes, give source:	
(Example: Family, SDI, Unemployment, Other)	

	
Are you employed?	If Yes, currently how long?        	
	If No, state reason.		
	
__________________________________________________________________________________________________________________________________________________
Have you (or others in your household) received assistance from Agape or another church in the past?	

No	

Yes	

If Yes, Amount Received	

Describe your level of involvement in your prayer group:  _____________________________________

___________________________________________________________________________________
	
Request:	TOTAL AMOUNT REQUESTED (required):		Date Needed By:		
Please state a summary of your need(s):	

	

Type of Monthly Income/Cash Available	Current Monthly Income Amount or amount earned before unemployed	Monthly Expenses	Expense Amount	
Your Wages		Giving		
Spouse’s Wages		Utilities		
Other Household Income		Groceries		
Social Security 		Eating Out, Coffee		
Disability Benefits		School Expenses		
Retirement Benefits		Car Payment		
Food Stamps		Cell Phone		
Unemployment		Gasoline		
Child Support		Auto Insurance		
Extended Family Support		Home Insurance		
		Health Insurance		
		Other Medical Expenses		
Total Income		Laundry & other home expenses		
		Clothing/Shoes		
Checking Account Balance 		Cable/Satellite/Internet		
Savings Account Balance 		Other Entertainment 		
Investment Accounts Balance 		Child Care		
Retirement Account Balance 		Child Support		
		Recreation		
Available Cash as of Today		Cigarette/Alcohol		
		Loan payments		
		Taxes		
		Mortgage/Rent		
		Other Expenses		
		Total Expenses		

Please prioritize your need(s):
	
Description of Expense	Purpose	Amount	

	

	

	

	
Describe your practice over the past year regarding giving, tithing, and honoring the Lord with your income:

_____________________________________________________________________________________
____________________________________________________________________________________What event(s) has occurred that prompted your need for assistance?	

	

	

Describe your ministry at Agape: __________________________________________________________

_____________________________________________________________________________________

Guidelines (please read before submitting this Application):

1.	Our Benevolence Assistance is designed to help our church family, someone who is an attender of at least 2 Sundays a month along with attending a Prayer Group or other Church Ministry.

2.	All forms of assistance are considered a process of helping the individual acquire the biblical disciplines and skills not only to maintain and manage their own affairs, but to also grow to a point where they become a potential resource of wisdom and knowledge to minister to others.

3.	We will not participate in supporting a lifestyle or decision process that is not biblical.  

4.	Potential recipients of any type of assistance must be willing to participate in guidance counseling or mentoring as determined by Benevolence Team at Agape.

5.	If you are a member of Agape Bible Church and have received assistance in the past, it is expected that you follow through on all recommendations from the Benevolence Team.  The responsibility to follow through on your commitments rest with the individual.

6.	Agape Bible Church has the right to refuse assistance to anyone.

AGREEMENT:  I have read and understand each of the above qualifications.  I understand that in making application for assistance, I am willing to allow Agape Bible Church to come along side to assist me in not only short term, but possibly long term guidance to resolve my present situation.  

Signature: ________________________________________

Upon completion of this application, please return to the church office (office@treasuringgod.com).