Financial Assistance

^{If you need financial assistance, please fill out this form to help us best serve you. We are currently only assisting approved individuals with food, utilities, or specific prescribed medications. All other needs will be deferred to other organizations. Follow up from the church office concerning your request may take 2 to 4 business days based on the severity of the request.}

First Name

Last Name

Birthday

Phone Number

Address 1

Address 2

Country

City

State

Zip/Postal Code

Have you accepted Jesus Christ as your personal Savior?

Are you a member / regular attendee of New Life Church?

What do you need financial assistance with? * i.e. Power Bill, Cost of Prescription, etc. Please be as descriptive as possible.

What is the Dollar amount of the Expenses?

Other Information