Financial Assistance Form | North Pointe

North Pointe has established a Financial Assistance Fund to provide short-term assistance to regular attendees, and at times, those in the immediate surrounding community.

This fund is designed to assist with financial needs when funds are available in the budget. Assistance from the church will take into account the use of one’s personal resources, including family assistance (such as parents, children, relatives, etc.) as well as their local church community network (such as a small group, area community, etc.). Any approved funds will be made payable to the provider of the service.

Wise stewardship dictates that assistance be extended when unexpected and serious circumstances develop, creating hardship in which the health, safety, or welfare of one or more members of the household is directly affected. Typically, these hardships are the result of a job loss, an accident, illness, or death in the immediate family.

We desire to help you. To ensure that we are serving you in the best manner and being good stewards of God’s resources, we need to understand you and your financial circumstances. Your information will only be disclosed to those involved with your situation.

Please know that:

Your request will normally take 5-7 days to evaluate and process.
We are NOT an emergency relief agency, we cannot hand out money, food, or provide on-site housing.
We have a limited budget and it runs out often.

Your name *

Email address *

Basic Information

Phone number

Spouse or significant other's full name (if currently living with you or supporting you).

Address

List everyone currently living in your home beside yourself: (Name, age and their relation to you.)

How long have you lived at your current address?

Are you applying for financial assistance to help pay for an upcoming church trip or church event? *

Employment Information

Current employer

How long have you worked there?

Previous employer

How long did you work there?

If you are currently unable to work, state why.

Spouse or significant other's current employer

If they are currently unable to work, state why

Is anyone in the household receiving disability benefits? If so, how much?

Church Background

Do you regularly attend North Pointe Community Church? *

Yes

If North Pointe is not your home church, what church do you call home?

If referred from a local agency in Lincoln, which one(s)

Does anyone at North Pointe know your situation? If so, explain.

Do you currently volunteer within North Pointe? If so, which ministry or area and who is your ministry leader?

How can we best help you?

To determine how and/or if we can be of assistance, please provide us the following information: What is your need today and what is the total amount you are requesting? *

*please attach a copy of the bill if there is one related to your request (required)

What is the crisis or situation that has caused you to ask for assistance?

If you are asking for assistance with a bill, please provide us with the name of the utility company and your account number.

Have you filed bankruptcy before? Please provide details and circumstances.

Approval Needed

Request Of Information *

I hereby authorize the release of information to North Pointe Community Church 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 NPCC may verify the information on this application and that deliberate misrepresentation of information may subject me to denial of assistance and/or services. I give permission for NPCC 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 UNDERSTAND THAT THE ASSISTANCE INTERVIEW PROCESS MAY INVOLVE POTENTIALLY UNCOMFORTABLE QUESTIONS AND ANALYSIS OF MY SITUATION AND SPENDING HABITS.

*I have read, understood, and agree to the policies above regarding the use of my personal information and the potential for discomfort in the Benevolence process.

Approve

Disapprove

Today's Date *