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Benevolence Application
We're glad you reached out. Please fill out all pertinent information.
Basic Info
Contact
✕
First Name
Last Name
Email
Phone Number
Address
Apartment, suite, etc.
City
State
Postal / Zip Code
Marital Status
Single
Married
Widowed
Separated
Divorced
I'd prefer not to say
Add another person
Please explain why you are applying for Benevolence funds.
Do you regularly attend Beit Tikvah?
Yes
No
Where is your church home?
How did you hear about BT?
Do you have children?
Yes
No
What are your children's ages?
Are you currently employed?
Yes
No
Employer's name
Employer's phone number
What kind of assistance do you need?
Who else have you contacted for help? (Select all that apply)
Family
Friends
Organizations
Other churches
Other
I have not contacted anyone
Other
Finances
Assets
Monthly Income (include all income from employer, spouse, pension, social security, child support, etc.)
Savings
Investments
Food Stamps/EBT card
Monthly Expenses
Please fill out as they apply.
Rent/Mortgage
Electricity
Water, Sewer, Garbage
Cell Phone
Cable TV
Internet
Food
Credit Card Balance
Car Payment
Gas
Auto Insurance
Health Insurance
Medical/Dental
Prescriptions
Childcare
I'd like to add other expenses
Other Expense #1
Other Expense #2
Other Expense #3
What is Other Expense #1?
How much is Other Expense #1?
What is Other Expense #2?
How much is Other Expense #2?
What is Other Expense #3?
How much is Other Expense #3?
Submit
