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Intermediate and Advance Benevolence Form

Page history last edited by Bonnyville Baptist Church 5 years, 7 months ago

                                                                              Bonnyville Baptist Church

Intermediate & Advanced Benevolent Assistance Form


Name of Individual: ___________________________                               Date: ___________________________

  1. How was individual referred? ____________________________________________


  2. Is the individual of legal age status?   YES/NO (if not legal parent or guardian’s financial status must be assumed)


  3. Are they receiving support from other churches or community assistance?    YES/NO


  4. Reason of need: 

    ___    Accident                   ____ legitimate financial difficulty          

    _____ Unavoidable unemployment situation (state reason) ___________________________

    ______   Other (state reason)  __________________________________________


  5. Are these funds being used for non-benevolent assistance?  Yes/No  (If yes please see senior pastor or admin team chair prior to giving monies) Please check which reason below:

  ____ Vacation                         ____Insured Losses                       _____ Business need

_____ Treatment not recognized by Canadian Medical Professional

_____ Individual on Social Assistance                             _____ Projected future needs 

  1. Has the individual been referred for spiritual assistance?  YES/NO

(The questions below this point only applies to Advance level assistance) 

  1. We have reviewed the following documentation and have approved advanced level of assistance:

    ____ most recent tax return                ____ paystub          ____ financial statement

  2. We have also considered the option of government support and resources available from other family  members/significant others?  YES/NO


Reason for granting assistance:_______________________________________________________

Name of individual(s) granting assistance:_______________________________________________

Signature of Individual(s) granting assistance:____________________________________________

If level is intermediate (food vouchers over the basic level  or cash over $150 and up to $750) this form is to be filled out by senior pastor,  or any one of the administration team and given to Administrator.

If level is advanced (over $750) this form is to be filled out and signed by senior pastor and any one of the administration team member, or any two administration team members and given to the Administrator.


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