Canyon View Vineyard Church

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, n/a etc.

City

State

Zip/Postal Code

Birthdate

Gender

Marital Status

How many adults live in your household?

How many children live in your household?

Housing

Rent

Own

Homeless

Employment Status

Yes

No

Other

Place of employment (If applicable)

Time of employment at current employer (If applicable)

Number of hours worked each week (If applicable)

What are your top 3 greatest strengths in this time of need?

Do you currently attend a church?

Yes

No

Where is your home church? (If applicable)

If you have a home church other than Canyon View, have you reached out to them for assistance? (We highly encourage you to reach out to your home church before reaching out to Canyon View)

Yes

No

N/a

How often do you attend church?

Never or less than once per year

A few times a year

Once a month

Weekly

How long have you attended your home church? (If applicable)

When was the last service you attended?

How often do you volunteer?

Never

Once or twice a year

Once a month or more

Have you applied for benevolence in the past?

Yes

No

Please describe the financial situation and how financial assistance improves your situation long-term (If applicable)

What specific life essential needs are you requesting

Dollar amount needed (Or estimate)

Have you applied for assistance elsewhere in the last 6 months? If yes, please list below. (Include assistance from CVVC)

How did you hear about our Benevolence Program?

Release of Information I hereby authorize the release of information to Canyon View Vineyard Church (CVVC) to receive the assistance I am requesting. I further certify the information I have stated is true and correct. I understand and give CVVC permission to verify the information on this application and to discuss my case with other agencies, businesses, churches, attorneys, individuals, and any others deemed necessary to verify application information. I understand that all information will remain as confidential as possible within these entities. I have read, understood, and agree to the policies above regarding the Release of Information.

By signing you accept the terms and conditions of this application.

Benevolence Application

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