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Benevolence Request

Benevolence Fund Application
We have limited funds availble to assist people in our local community (the greater Rogue Valley of Southern Oregon)
If you are outside of the Rogue Valley, we encourage you to find a local church to assist you
In order to apply for funds, you must check that you have read and understood the CBC Benevolence Fund Policy
Your Name   Contact Phone
Email   Do you attend CBC? Yes     No
Home Address
(Include City & Zip)
  If yes to above, how long?
How long have you live at the
above address?
  If not CBC, do you attend a church? Yes     No
Number of people in the home   If yes to above, what church?
Are you currently employed? Yes     No   Statement of need (dollar amount)
If yes, where are you employed?   What will the money be used for?
Rough monthly household income   Purpose/Cause of need
(loss of job, medical issues, etc.)
Monthly expenses/debt (dollar amount)   Who else have you contacted for assistance?
Do you have/use a household budget? Yes     No   Their response
Will you be in need again next month? Yes     No   What is your plan for next month?
Have you ever received
financial counseling?
Yes     No   Are you willing to get financial counseling? Yes     No
Questions/Comments for us:   Have you requested from CBC before? Yes     No
If this is for rent or a bill,
fill out the following
Funds for bills are paid 
directly to the owed party
Type of Bill
Check needs to go to
Address (Include City & Zip)
Contact Number

Please note  
There is a process to evaluate requests 
that may take a few days.  
Benevolence Fund Policy   I Read and Understood the
Benevolence Fund 
  No Cash will be given