Financial Assistance Request Form • Christian Life Church

About You

Full Name *

Phone Number *

Email Address

Tip: (optional but helpful)

Are you a member/regular attender of CLC? *

Assistance Requested

Explain - Other Assistance Requested:

Briefly describe your situation and need: *

Tip: Please be as specific as possible. All information is confidential.

Total amount requested: *

Have you received assistance from CLC before? *

When? *

Verification

Some financial assistance requests may require documentation such as bills, notices, identification, or proof of hardship. Please be prepared to provide supporting documents if requested.

If you have documents ready, you may email them to clc.maryland@gmail.com

Other Support

Have you requested help from any other organizations or family? *

Requested Help *

Are you currently employed? *

Follow-Up

Best time to contact you: *

Preferred method of contact: *

Phone

Email

Text

Important Acknowledgements

Check Boxes *

I understand submitting this form does not guarantee financial assistance.

I certify the information provided is true and accurate.

I authorize CLC to contact me about this request.

Privacy Statement

Your information will only be shared with CLC leadership involved in benevolence decisions and will be kept confidential.