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Benevolence Request

Are you a member or regular attendee of Divine Empowerment Church?
Member/Tithe Payer
Regular Attendee
First Time Guest
Online Attendee
Household Information
Are you currently employed?
Full-Time
Part-Time
Self-Employed
Unemployed
Retired
Assistance Requested
What type of assistance are you requesting? (Check all that apply)

Add the amount you need without the dollar($)

Have you received benevolence assistance from Divine Empowerment Church before?
Yes
No
Previous Assistance

If Yes:

Date
Month
Day
Year
Have you sought assistance from family, friends, government agencies, or other organizations?
Yes
No
Payment Information

Preferred Method of Receiving Approved Assistance

Please be sure type in the correct information for your payment

Account Type:
Checking
Savings

If you are approved for benevolence assistance, do you anticipate being able to voluntarily repay all or a portion of the assistance in the future?

Choose one
Yes
No
Other
Certification & Authorization

I certify that the information provided in this application, including any payment information, is true, accurate, and complete to the best of my knowledge. I understand that submitting this request does not guarantee financial assistance and that all requests are reviewed based on available resources and Divine Empowerment Church's benevolence policies.


If my request is approved, I certify that the payment information provided belongs to me or is authorized for me to receive assistance. I understand that inaccurate or incomplete payment information may delay or prevent the processing of approved funds.


By signing below, I acknowledge that I have read and understand the terms of this application.

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