Assistance Request Form - HighRidge Church Longview

Basic Info

Phone number *

Are you a member of HighRidge Longview? *

Yes

No

Are you currently part of a HighRidge Group? *

Yes

No

What type of need is this?

Groceries

Other

Please describe your need in detail below. *

Have you received assistance from the church in the last two years? *

Yes

No

I'm not sure

Are you receiving assistance from any other organizations for this need? *

Yes

No

Is this assistance for you or your immediate family? *

Yes

No

What is the amount needed, and what date do you need it by? *

How much can you afford to pay toward this need? *

Are you currently employed? *

Yes

No

Do you tithe 10% of your income on a regular basis? *

Yes

No

I understand that my need will be reviewed and a church representative will contact me within one week ONLY if my request is approved. *