CanyonViewVineyardChurch

736 24 1/2 Road, Grand Junction, CO81505

970-242-7970

BENEVOLENCE

The Helps Team of Canyon View Vineyard Church is charged with determining who is needy and defining what constitutes a true need according to Biblical standards. Our decisions are made in accordance with the mandates of Scripture and the leading of the Holy Spirit. These funds come from the blessings that the Lord has given us. We are charged with being good stewards of God’s Resources that was given by people living obedient, disciplined lives for the support of those in need of emergency assistance. We are concerned about your spiritual needs as well as your physical needs.

ALL QUESTIONS ON THE APPLICATION FORM MUST BE COMPLETED.

  1. The primary objective of the Helps Team of CVVC is to assist those inemergency need of assistance.
  1. No benevolence is ever administered to relieve the consequence of sin.
  1. All benevolence is given to assist the recipient to help himself/herself work through the problem, not to bail them out of the situation with no effort on their part.
  1. All benevolence checks will be made payable to the debtor in cases of bills (i.e. landlord, electric co.) and only in rare circumstances to the recipient of the financial aid.
  1. Requests for benevolence requires review by the Helps Team of CVVC, which normally takes up to fourteen (14) days. All applications must have a signed authorization for release of information before processing can begin. We will contact the applicant when the team has reached a decision.
  1. CVVC will assist people in need only in obedience to the Lord’s will and cannot be dictated by the urgency of circumstances.
  1. Every case is CONFIDENTIAL. Violating confidentiality may result in disqualification of any request submitted, either currently being considered or in the future.
  1. Proof of income is required with copies of last two pay stubs attached.
  1. Copies of bills must accompany request.
  1. All questions on the application form MUST BE COMPLETED, or the form will be returned to applicant for completion before we will process the request.

CANYONVIEWVINEYARDCHURCH BENEVOLENCE REQUEST FORM

RESPONSES TO QUESTIONS MUST BE PROVIDED IN ORDER FOR APPLICATION TO BE CONSIDERED

PERSONAL INFORMATIONDate______

Last Name ______First______Maiden______

Address ______Apt.______

City______State ______Zip______

Phone: Day # (____) ______Evening # (_____) ______E-mail______

Sex (M/F) ______Birth Date ____/____/____ Age ______

MARITAL STATUS

___ Single ____Engaged ___Married ___Separated ___Divorced ___Widowed

INFORMATION ON SPOUSE

Last Name ______First______Maiden ______

Address ______Apt.______

City______State ______Zip ______

Phone: Day # (_____) ______Evening# (_____) ______

Sex (M/F) ______Birth Date ____/____/____ Age ______

PLEASE LIST SPECIFIC REQUEST NEEDED AT THIS TIME

Amount For

$ ______Food ______

$ ______Clothing______

$______Utility/Which One?______

$______Prescription______

$______Rent/House Payment______

$______Other______

EXPLAIN HOW YOU CAME TO BE IN THIS FINANCIAL SITUATION

______

______

______

______

______

HOUSEHOLD MEMBERS -- List ALL persons living at this address

NameDate of BirthRelationship Income

______

______

______

______

______

Do you have a Social Worker? ___Yes ___No Social Worker______

Agency______Phone______

APPLICANT’S EMPLOYMENT HISTORY

Present/Most Recent Employer______Phone (___)______

Supervisor ______Phone (___)______

Address ______Apt.______

City______State ______Zip ______

Employment Date ______to______

Position and Job Description ______

Reason for leaving (if not currently working) ______

SPOUSE (OR FAMILY MEMBER’S) EMPLOYMENT HISTORY

Present/Most Recent Employer______Phone (___)______

Supervisor ______Phone (___)______

Address ______Apt.______

City______State ______Zip ______

Employment Date ______to______

Position and Job Description______

______

Reason for leaving (if not currently working) ______

______

HOUSING

___Own/Purchasing ___ Renting How Long at Present Address ______Other______

Landlord/Mortgage Co.______Phone (___)______

Address ______Apt.______

City______State ______Zip ______

MUST BE FILLED OUT COMPLETELY, INCLUDING TOTALS, TO BE CONSIDERED

WHAT I OWN (today’s value)WHAT I OWE (unpaid balances)

Checking Accounts $______Mortgage (balance) $______

Savings Accounts $______Home Equity Loan $______

Money Markets Funds $______Taxes-list city, real estate etc.$______

Certificates of Deposit $______Insurance $______

Mutual Funds/stocks/bonds $______Master Card/Visa $______

Life Insurance (cash value) $______Dept. Stores $______

Home (market value) $______Gas Card $______

Car (yr___make____) approx.value $______Other Credit Cards $______

Car (yr___make____) approx.value $______Bank Loan $______

Other Property Market Value $______Finance Company $______

IRA(s) Retirement Funds $______Furniture/Appliance $______

Other ______$______Car Loans $______

______$______School Loans $______

______$______IRS Debt $______

Other ______$______

______$______

______$______

Total $______Total $______

MONTHLY INCOMEMONTHLY EXPENSES

(If weekly, multiply by 4)

Employment Rent $______

Job 1 (actual take home pay) $______Mortgage $______

Job 2 $______Real Estate Tax & HO Ins$ ______

Spouse Car Payment(s) $______

Job 1 (actual take home pay) $______Auto Insurance $______

Job 2 $______Electric $______

Child Support $______Gas $______

Retirement $______Water $______

Social Security $______Food $______

SSI or Disability $______Phone(s) $______

Food Stamps $______Cable TV $______

VA $______Child Daycare $______

Unemployment $______Child Support $______

AFDC $______Life Insurance $______

Dividends/Interest $______Contributions $______

Other ______$______Credit Cards $______

______$______School Loans $______

______$______Bank Loans $______

______$______Finance Co. Loans $______

______$______Furniture/Appliances $______

Other ______$______

______$______

Total $______Total $______

ADDITIONAL INFORMATION

Have you seen a financial planner/advisor within the last 6 months?___Yes ___No

Who? ______

Have you contacted anyone else for assistance within the last 6 months?___Yes ___No

Please specify amount(s) received______

Family/Friends______

Churches/Agencies______

What steps are you taking to improve your present situation?______

______

What is the name of your church?______

(If CVVC, whichcampus do you attend? ____Downtown____Clifton

Address ______Phone (____)______

Minister/Pastors Name______Phone (____)______

Do you regularly attend church?___Yes ___No Since______

How frequently ______Are you a member? ___Yes ___No

Who suggested that you contact CanyonViewVineyardChurch? ______

Relationship______Phone (____)______

Have you previously received help from CanyonViewVineyardChurch? ___Yes ___No

When?/What? ______

Reference Names Phone Relationship

______

DESCRIBE YOUR RELATIONSHIP WITH JESUS CHRIST AT THIS TIME:

______

______

Release of Information

I hereby authorize the release of information to Canyon View Vineyard Church (CVVC) to receive

the assistance I am requesting. I further certify the information I have stated is true and correct

and that all income is reported. I understand CVVC may verify the information on this application

and that deliberate misrepresentation of information may subject me to denial ofassistance/services.

I give permission for CVVC to discuss my case with other agencies, businesses, churches,

attorneys, individuals, and any others deemed necessary to verify application information and/or

identify additional sources of assistance. I understand that all information will remain as private

as possible within these entities.

I have read, understood, and agree to the policies above regarding the Release of Information.

______

Signature Date

A new commandment I give to you, that you love one another, even as I have

loved you, that you also love one another. John 13:34