Confidential Financial Request Form

This form is used by the Benevolence Team at State College Alliance Church. All information is confidential and will only be shared within our team. We have a limited resource available to share with those in our community. Any gifts will be paid directly to creditors, not to the requestor. Our focus is on short term, emergency type of needs.

Your name *

Email address *

Phone number *

Address

If someone is assisting you in filling out this form, please enter that person's name and their preferred contact information.

Please describe the nature of your need. *

How much money are you requesting? *

When are the funds needed?

Or you can request to wait until the beginning of the next month

Do you regularly attend a church? If so, what is the name of your church?

Please provide any documentation you have for this request.

ie: images or photos of utility or medical bills, credit card statement, or other documentation.
This documentation should include the requestor's name, account information, and amount due so that our treasurer can pay the bill directly.

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