Financial Aid Request Form

The purpose of Starpoint Church's Benevolence Fund is to provide financial aid to individuals and families who are in need on an urgent basis. The Benevolence Fund is not applicable for cases which need long-term financial support and is only available to those who are connected to Starpoint Church. The church has the right to adjust or to disapprove an applicant's request and may consider providing assistance other than monetary help. The benevolence is funded by the generous donations of those who call Starpoint Church home.

Applicants for financial assistance are awarded financial assistance based on financial need and connectedness to Starpoint Church. The church does not discriminate applicants based upon race, color, sex, national origin, age, or disability.

Please answer the following questions as fully and completely as possible. Incomplete or vague answers may impact the request.
Date

Check choose one

FAMILY INFORMATION (If you are unmarried and have no children skip to next section)

STARPOINT CHURCH INFORMATION

BENEVOLENCE REQUEST INFORMATION

Date

Starpoint Church does not provide cash to applicants. The church may provide, at its own discretion, gift cards for groceries or gas or a check payable to a specific creditor.

I hereby authorize the release of information to Starpoint Church to receive the assistance I am requesting. I further certify the information I have provided is true and correct and that all income has been reported. I understand that Starpoint Church may verify the information on this application and any deliberate misrepresentation of information will be subject to denial of assistance or services. I authorize Starpoint Church to discuss my case with other agencies, businesses, churches, attorneys, individuals, and any others deemed necessary to verify accuracy of information and/or identify additional sources of assistance. I understand that all information will remain as confidential as possible within these entities. Starpoint Church does not accept any responsibility for any loss related to or cause by reliance on the information provided. The materials contained herein are provided for general information purposes only and do not constitute legal or other professional advice on any subject matter. I have read, understand, and agree to the disclaimer/release and the Starpoint Church's Benevolence Policy.