Download Financial Assistance Request Application

Financial Assistance Request Application
Oak Hills Church has established a Benevolence Fund for the purpose of providing short-term financial
assistance to members (and some regular attendees) who have experienced an unexpected and
potentially catastrophic event that causes severe financial hardship. Typically, these hardships are the
result of a job loss, an accident, illness or death in the immediate family that prevents the normal
operation of one’s life and family. The Benevolence Fund is designed to assist with needs up to the
amount of $1,500.00 and is offered only after all other primary resources have been utilized, including
personal savings and retirement funds, family assistance (such as parents, children, relatives, etc.) as
well as their local church community or friendship network (such as a small group, area community, etc.).
If the situation is considered to be a qualified financial emergency, then help may be available through
the Benevolence Ministry. Credit card debt, unpaid monthly bills or cash flow problems are not normally
considered qualified financial emergencies unless incurred or impacted by a crisis event, such as
described above.
Since the ministry is funded by the church, approval is based on specific criteria, and approved funds are
to be made payable to the provider of the service. No money will be given to the member.
In order to apply you must establish the following:
Be an active member or regular attendee of the Oak Hills Church.
Have no other financial resources available to you or have already exhausted those resources.
You must complete the following steps:
Read the application completely, and note what constitutes an eligible expense.
Complete all information on the application, and sign it.
Attach a letter explaining your financial emergency with all supportive information requested (see
Application).
Examples of eligible expenses may include but are not limited to:
Funeral expenses
Monthly bills – Rent/Mortgage, Utilities, etc.
Medical bills not covered by insurance for necessary, non-elective medical treatment
Relocation to another residence because of fire, flood, or domestic violence
Examples of ineligible expenses include but are not limited to:
Attorney fees
Reimbursement for unpaid sick time
Tuition expenses
Income/Property taxes
Bail money
Credit card debt
Car payments/insurance
Bill consolidation loans
Relocation to another residence when it is not the result of fire, flood, or domestic violence
Home repairs (excluding those resulting from fire, flood, or other catastrophic event)
Oak Hills Church Financial Request Application
MEMBER INFORMATION (COMPLETE /REVIEW ALL SECTIONS)
NAME:
OCCUPATION:
ARE YOU A MEMBER?
CAMPUS YOU ATTEND:
AREA COMMUNITY:
WORK TELEPHONE:
HOME/CELL TELEPHONE:
O.K. TO LEAVE MESSAGES AT PHONE
NUMBERS?
ANNUAL SALARY:
EMPLOYER:
___ Yes
___No
TOTAL HOUSEHOLD INCOME:
$ ________________________
HOME ADDRESS: (Including City, State & Zip)
___ Own
___ Rent
DO YOU OWN PROPERTY OTHER THAN RESIDENCE: ___ No
Amount Requested: $_____________________
___ Yes (If “yes”, type of property and location.)
Date: _____________________
Information on your Financial Emergency Hardship Situation
Attach a letter explaining your situation that includes the following information:
1.
The reason for your request:
What happened?
To whom?
When?
How?
2.
The steps that you have taken to resolve the financial hardship and include information on the following:
Credit cards
Retirement/401(k) funds/stock options
Personal loans
Savings
Home equity loans
Debt consolidation
Insurance
Other
3.
Any other financial resources available to you, such as investment properties, bonus, additional household income,
etc.
4. Why your personal resources are inadequate.
Documentation required with your application. In order for your application to be considered, you must include copies of
the following documents for yourself. (Please note, these documents will not be returned to you.)
Copies of prior month’s checking and savings account statements (all pages)
Copy of most recent pay statement
Copy of 401K statement
Copy of credit card statements
Copies of any bills and documentation for payment consideration (signed lease agreements, medical bills not covered by
insurance, funeral bills, police reports, fire reports, etc.)
Itemized list of losses (relocation resulting from fire, flood, or catastrophic event)
By signing below, I certify that the statements made above and on any attachment(s) are true and complete as of the date given
below. I authorize Oak Hills Church to verify or check any of the information given and talk with an elder or neighborhood
community leader or campus minister. I further agree and understand that any misstatement or omission of fact or failure to
substantiate, with documentation, my request for emergency financial assistance may result in disqualification or denial of my
request.
SIGNATURE: _______________________________________________ DATE: __________________________
Please send this application, the letter explaining your situation, and required documentation to:
Mailing Address:
Oak Hills Church
Crownridge Campus
6929 Camp Bullis Rd.
San Antonio, TX 78256
Office Address:
Oak Hills Church
Crownridge Campus #A217
19595 IH 10 West
San Antonio, TX 78257