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Basic Benevolence Assistance Form

Page history last edited by Loraine 4 years, 4 months ago

Bonnyville Baptist Church

Benevolent (Gift Card/Gas/Prescriptions) Assistance Form


Advise recipient that we are not a social service agency, we depend on donations from our people and we cannot provide long-term assistance.     Limits on assistance for gift cards are $75/month to a maximum of $475/year per family and For individuals $275/year.


1)      How was individual referred?  _______________________


2)      Is the individual of legal age status?   YES/NO

(if ‘no’ legal parent or guardian’s financial status must be assumed)


3)      Have they gone to the Food Bank?  YES/NO


4)      Are they on social assistance?   YES/NO  


5)      Has the individual received gift cards in the last calendar year?   YES/NO


6)      Reason applying for assistance: 

____   Accident

____   Legitimate financial difficulty                

____   Unavoidable unemployment situation (state reason) ___________________________

____  Other (state reason)  _____________________________________________________


Assistance beyond the basic must be approved by the Senior Pastor and requires proof of financial need.

Name of Individual being granted assistance: ______________________________________________________

Name of individual(s) granting assistance:_____________________ ___________________________________


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