INSTRUCTIONS: Please complete this form as best you can. Incomplete information will delay processing of your request. Compassion Ministry Committee may further request information on your household income and expenses. All the information and any documentation you provide will be held in strictest confidence.

Today's Date *

YYYY

TELL US A LITTLE BIT ABOUT YOURSELF:

Name *

First Name

Last Name

Your Family: *

Where do you live? *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Employment History (current, previous) *

What do you know and believe about Jesus Christ? *

Phone *

(###)

###

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Email Address *

HOW CAN WE HELP YOU?

Describe your situation *

How much do you need? *

Date needed by: *

YYYY

NOTE (please read):

We do not give cash or issue checks payable to applicants. If your request is approved we will need the name and address of your creditor and/or vendor and your account number.

TELL US ABOUT YOUR RELATIONSHIP WITH FRIENDS COMMUNITY CHURCH

How long have you been attending FCC? *

Which worship service do you normally attend? *

Which FCC Ministries have you served with or been involved with? *

(check all that apply)

Children's Ministry

Middle School Ministry

High School Ministry

Young Adults Ministry

Worship Ministry

Usher/Greeter

Women's Ministry/Women's Bible Study

Men's Ministry/Men's Bible Study

Life Groups or Rooted Groups

Stephen Ministry

OWLS (Seniors 55+)

Trustees or helping with building projects

Other (specify below)

If "Other," please specify: *

Please provide the name of an individual, preferably a non-FCC Staff, who knows you and attends FCC *

First Name

Last Name

Phone # *

(###)

###

####

Which church, if any, do you attend besides Friends Community Church? *

Your request for assistance has been successfully submitted. Thank you!

Friends Community Church, 620 W Lambert Rd, Brea, CA, 92821, United States(714) 529-3114info@fccbrea.org

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