Assistance Request Form

United Community Church strives to be an active and helpful part of the community. Since the church has limited funds, we want to be the best manager of our resources. Please taking a few minutes to answer the following questions to help our church determine if you meet our assistance guidelines.

First Name

Last Name

Mailing Address

Mailing Address Line 2

Mailing City

Mailing State

Mailing Zip Code

Mobile Number

Do you have a valid Georgia Driver's License or I.D.?

Is your current address different than the address shown on your Georgia Driver's License or I.D.?

Are you a member of another church?

Have you applied for financial assistance from this Church in the past 12 months?

Have you applied for financial assistance anywhere in the past three months?

Do you live within the State of Georgia?

Does your request exceed $200?

Are you facing eviction within the next seven days?

Are you applying for assistance with a phone or cable bill?

Are you currently employed? If so, where?

Are you willing to attend financial counseling or a small group Bible Study if asked?

Briefly describe the circumstances you are in and the assistance you are requesting: