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Benevolence Request

We are looking forward to our time with you. We view it as a time to get to know you and understand what is happening in your life. Our goal is to try to connect you with resources and/or resource providers, give you some encouragement, and possibly provide you with new ideas and perspectives to apply to your current situation.

We know that there is so much more to you than the struggle you are having right now. We also know that a struggle in one area of our lives is connected to other areas of our lives. The following questions are designed to explore some of these areas.

For your appointment
If for some reason you cannot keep your appointment, please contact us immediately to reschedule. Please call the church office at 212-838-6844

(mm/dd/yyyy)

First Name
Last Name

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country





(mm/dd/yyyy)


Current Situation


Have you asked for or received assistance from the following? What was the specific outcome of your request?




Health and Relationships




Spiritual and Self-Development





Monthly Budget Information ($ USD)
Enter numbers without decimals, commas, or dollar signs. For instance, an expense of $10 will be entered as 10.

HOUSING






UTILITIES





COMMUNICATION






INSURANCE






DEBT REPAYMENT





PERSONAL COST





PROFESSIONAL SERVICES





PERSONAL








ENTERTAINMENT






MISCELLANEOUS





MONTHLY INCOME










ASSETS












DEBTS







Agreement with Trinity Baptist Church

I understand that Benevolence will attempt to assist me in addressing my current needs. I acknowledge that consulting with the Benevolence Ministry may involve the sharing of my information with other ministries at Trinity Baptist Church on a “need to know” basis, and I authorize such sharing of information with Trinity Baptist Church. I understand that the services provided by Benevolence are offered without charge or obligation.

I further agree to indemnify and hold harmless all volunteers of the Benevolence Ministry, Trinity Baptist Church, and its employees, agents, counselors, officers, and directors from any claim, suit, action, demand, or liability of any kind and any nature arising out of, or in any manner connected with, my participation in the Benevolence Ministry’s services.