CARE ELIGIBILITY

CARE ELIGIBILITY QUESTIONNAIRE

The purpose of the Care Ministry Benevolence Program of Element Church is to assist people in achieving or regaining their independence in body, soul, and spirit while maintaining their dignity. We realize that anyone can fall on difficult times. As the family of God, we’re in this together. We are not here to give you a hand out, but a hand up!

If you are experiencing financial difficulties, and you are an active member of Element Church (active membership is determined by enrollment in or completion of Growth Track classes, consistent weekend service attendance, faithfulness in giving, and small group involvement) this is your first step to requesting assistance. Your responses to this questionnaire will be reviewed by our office within 2 business days. If you qualify for assistance, you will receive a formal application asking more in-depth information.

PERSONAL INFORMATION

Name *

First

Last

Phone *

Email *

Are you married? *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

CHURCH AFFILIATION

Do you attend Element Church on a regular basis? If so, which campus? Due to budget constraints, we are sorry to say that if you are not an active member of Element Church you do not qualify for Care benefits. *

Wentzville
St. Charles
Online
No, I do not attend regularly

How often do you attend? *

Weekly
Once or twice a month
Occasionally
Never, I do not attend

Do you give regularly at Element Church? *

Are you currently volunteering at Element Church? *

Who referred you to the Pastoral Care Team for assistance? *

BENEVOLENCE REQUEST DETAILS

Please tell us about your situation. Please note: This request is for pre-approval and we will ask for more information from you if we are considering your request for final approval.

Please describe your need- What type of assistance are you requesting? (i.e. water bill, etc.) *

Approximate Amount of Assistance Requested. *

Have you received assistance from Element Church or ANY other ministry or agency during the past 6 months? *

Submitting this questionnaire does not guarantee approval for assistance. Our team will review the information you provided and let you know if further information is needed. Thank you!