Financial Assistance Form - Sweetwater First Assembly

Address *

Phone number *

Marital status *

Spouse’s Name

How many dependents live with you? *

0

1

2

3

4

Other

Are you involved at Sweetwater First Assembly? If so, how? *

What county do you live in? *

Please explain your current financial situation. *

In your opinion, which description best describes your current financial situation? *

Short-term Crisis

Short-term Problem

Long-term Problem

Other

Is there anything we can pray about with you? *

What financial need do you need covered? *

City/Electrical Bill

Rent

Other

If other, please explain your need.

How much money do you need to cover the current need? *

If you are looking for assistance with your utilities, please provide the name of your utility company and your account number.

How do you see your situation improving? *

Additional Assistance

Are you receiving help from any of the following? *

Unemployment

Welfare

Food Stamps

WIC

Social Security or Disability

Sweetwater Area Ministries (SAM)

Fresh Start

Other Individuals

Other Churches

No other assistance

Other