Application

Christmas Assistance Application

*This application form is confidential. Please complete the application form below in its entirety. Incomplete forms will not be eligible for consideration. Application Deadline: Saturday, November 30th, 2019.

Eligible Recipients: Assistance is for those in need due to financial / economical situations. We're praying that those nominating or applying will be honest for this is to benefit someone truly needing assistance this holiday season. This year our goal is to award 20 families with holiday assistance to purchase gifts and holiday dinner fixings. Selected recipients will be notified of the date to meet leaders at our local Super Wal-Mart on Bay Road in Saginaw, MI to shop. Transportation will be provided for those that don't have reliable transportation.

Brief Assistance Application
*Denotes Required fields.

* Indicates required field

Are you nominating a family? *

Yes No

I am nominating myself? Need Based *

Yes No

If nominating a family please type your full name. If not continue to recipients information. *

Recipients Full Name (First & Last Name) Head of Household *

Recipients Date of Birth. Example: MM/DD/YY *

Best number the recipient can be reached at? *

Recipients Full Home Address (Street, City, State, Zip) *

Recipients Household Income? *

$ to $5,000 Year $5,000 to $15,000 Year $15,000 to 25,000 Year $25,000 to $35,00 Year

List Recipient's Children in the household only. List full name, age, sex: boy or girl. Example: John Doe, Age: 7, Boy *

Give brief summary of why you think the recipient is deserving of this assistance? *

Submit

Christmas Assistance Application

Brief Assistance Application *Denotes Required fields.

We Would Love to Have You Worship With Us Soon!

Brief Assistance Application
*Denotes Required fields.