midlandevangelicalfreechurch

7221 N.Jefferson Avenue, Midland, MI 48642-8214

989.631.4411

www.mefchurch.org

We as a church want to minister to those who attend and help them turn to God and His people through crises and difficult life experiences. Our policy is to help members/attenders of Midland Free. All others are referred to CareGiving Network, 211 First Call for Help (United Way), Salvation Army and Midland Area Homes.

Note: Monies are sent directly to entity money is owed, not the individual. Upon approval, Midland Evangelical Free Church will direct funds to a landlord or business, not the individual church member.

BENEVOLENCE APPLICATION

Name, Address & Contact Number / Click here to enter text.
Are you a member or regular attender? How long attended?
(double click on box to x) / ☐ Yes ☐ No (if no, we would love to help you by
connecting you to other organizations
in the community.)
Where are you connected?
(Please put leader’s name, group name, or ministry serving in) / Life Group
Serving
Other (classes, mentoring, etc.)
Click here to enter text.
NEEDS
How do you want Midland Free to help? / ☐ Gas Card or Food Card
☐ Housing, utilities, automotive, other
☐ Counseling
What is the dollar amount of your need? / Click here to enter text.
Are you currently working? / ☐ Yes (how long?) ☐ No
If helped, how will you meet these or similar needs in the future? / Click here to enter text.
Do you have a budget? / Click here to enter text.
If approved, who and where does payment go? Provide name, address and phone number. (Please submit a bill or a copy of a bill.) / Click here to enter text.
If seeking counseling who is the counselor? Name, address, phone number. / Click here to enter text.
For what reason are you seeking professional counseling? / Click here to enter text.
Do you have insurance or an EAP which will help with costs? How much are you able to pay each session? If approved we will help with 6 sessions. / Click here to enter text.
How have you been assisted by family, friends, churches, governmental agencies, public and private organizations for money, food, clothing, or payment of any of your bills in the last year? / Click here to enter text.
Who in the congregation can verify your need? Please provide name and phone number.
(Cannot be Midland Free Pastors or Staff) / Click here to enter text.
Are you willing to pay back as God provides or by volunteering at the church? / Click here to enter text.

I give my permission to Midland Evangelical Free Church to release and request information to help my case. This information is held in confidence unless deemed necessary to assist. I understand the Benevolence Team will discuss my request.

SIGNATURE: __Click here to enter text.______DATE: __Click here to enter text.______
(Submission online represents an electronic signature)

Please give specific dollar amount you are requesting. If you have a service estimate, please attach this information. Specific requested dollar amount or estimate: $ Click here to enter text.

Check List: (Midland Free will not consider your request unless all of these things are complete)

Have you signed this release? ___Click here to enter text.___

Have you filled in all the boxes? ___Click here to enter text.___

Please include the original bill or a copy of the bill for our reference? _Click here to enter text._____

Please print the entire form, sign and date. Submit completed form to Gib Giblin, Care Pastor for Benevolence Team Review. Form can be returned to:

·  the church office, 7221 N. Jefferson Avenue, Midland, MI 48642

·  put in Care Ministries locked wall mailbox in the church mailroom

·  electronically – or