Financial Assistance Application

Please answer each question completely and accurately. Send any additional documentation that is requested, such as your lease or mortgage agreement, bank statements, billing statements or any other related documents pertaining to your financial request to:

Please know that your request will normally take 2-3 days to evaluate and process and submission of this form is not a guarantee of financial assistance.

  • List everyone currently living in your home beside yourself:

  • Employment Information:

  • Church Membership Information:

  • Years/Months
  • Financial Information:

  • Household Expenses & Income Information:

    Expenses Per Month:
  • Income per month:
  • By typing my full name below, I certify that the statements made above and on any attachment(s) are true and complete to the best of my knowledge. I give permission to the CLF Benevolence Team to make inquiries as needed to determine if they are able to assist me.