King's Church Las Vegas

King's Church Benevolence Assistance Application Form

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Birthdate

Marital Status

Email

Phone Number

Are you a member or regular attender of King's Church?

Yes

No

In your opinion, what best describes your financial situation?

Short Term Emergency

Short Term Problem

Long Term Problem

The total amount of your request is?

What is it for?

To whom should we make the check payable to?

Are you currently employed?

Yes

No

If so, who is your employer?

If married, is your spouse currently employed?

Yes

No

If so, who is your spouse's employer?

Please provide the name of a reference:

Reference Phone Number

Total number of people in the household?

Briefly explain your needs and what led you to apply for assistance