Benevolence Request Form

Name(*)

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Email(*)

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Phone #(*)

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Address(*)

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Do you have a personal relationship with Jesus Christ?(*)

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Are You A Member Of Eagles Nest Church?(*)

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Which best describes your attendance at Eagles Nest Church?(*)

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In your opinion which description best describes your financial situation?(*)

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Total Amount Requested(*)

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What is it for?(*)

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Attach Bill

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Who should we make the check payable to?(*)

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All payments will be made directly to the service provider, landlord, or appropriate party. Funds will not be given directly to the individual requesting assistance

Service Provider Address

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Are you willing to receive financial counseling?(*)

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Are you currently employed?(*)

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Name Of Employer

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If married, is your spouse employed?

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Name Of Employer

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Total number of people in the household(*)

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Total weekly household income(*)

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Briefly, explain your needs and what led you to request assistance. We will be praying for you and providing counsel where needed(*)

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What other resources have you tried?(*)

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By submitting this form, I affirm that the information provided is true and accurate to the best of my knowledge. I understand that the church may use this information to determine my eligibility for assistance and may contact me for further clarification if needed. I consent to the church leadership reviewing this request and understand that submitting a request does not guarantee approval or assistance.

Electronic Signature(*)

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Security Check(*)

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Eagles Nest Church International

2126 Pipe St Sandusky, Ohio 44870

(419) 626-5081

eaglesnci@gmail.com