Financial Assistance Request Form

Assistance is intended to be used when the individual or family has explored all other options from appropriate sources (i.e., family, savings, and local organizations such as Bluffton Self Help, Beaufort-Jasper Economic Opportunity Commission, and Family Promise who exist to provide support and assistance to those in need as their primary focus).

Please do not apply until you have explored other options.

Preference regarding Financial Assistance will be given to Members and Regular Attendees. Other requests will be considered as opportunity allows.

Galatians 6:9-10 “Let us not lose heart in doing good, for in due time we will reap if we do not grow weary. So then, while we have opportunity, let us do good to all people, and especially to those who are of the household of the faith.”

Your name *

Email address *

Phone number *

Address *

Birthdate *

Marital status *

Do you currently attend a church? *

If yes, where do you attend church?

If you do attend another church, have you requested their assistance? What has been their response?

Who referred you to our church for assistance? *

Information about your work and income:

Are you currently employed? *

Employer (or past employer) name and phone number: *

Date of last employment if no longer working:

If you are unemployed, are you seeking employment:

What other agencies have you applied to for help and what has been their response? *

Are you currently receiving financial assistance of any kind? *

If yes, from what source?

Please note:

Bill(s): utilities (water, sewer, electric, and gas) are given preference; others are considered.

We will NOT consider payment (or partial payment) of fines/penalties, child-support, credit cards, TV cable, cell-phone service, storage rental, hotel stay or medical.

We typically won’t consider rent assistance unless there are extenuating circumstances and there is proof of ability to “pay in full” the remainder. We are unable to pay full rent but will sometimes come alongside you and other agencies to meet a smaller gap.

What bill do you need assistance with? *

If approved, what company and address should we write the check to? Payment will be sent directly to the company. *

Bill Amount? *

Amount of funds you have available toward this bill? *

Please explain your need and the circumstances surrounding your situation. *

How do you plan to pay this and other bills next month? *

Upload supporting documents such as a lease agreement and notice of balance due (with account number), utility bill, etc. If approved, disbursement will be made directly to the service provider by check. *

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Add up to 5 files. Maximum file size 10 MB.

I affirm that all the information provided is true and correct to the best of my knowledge. *

Please upload a photo id (such as a driver's license or state id). *

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Choose 1 file. Maximum file size 10 MB.

My electronic signature: *

Only 1 financial assistance approval:

Only 1 financial assistance approval for non-Members and non-Attendees in any given time period.

Only 1 financial assistance approval in any 12 month cycle for Members and Regular Attendees, unless there are extenuating circumstances. A second request will NOT be accepted from anyone without a Christian based financial counseling session prior to the approval, regardless of time interval between requests. Maximum cumulative benefits will be on a case by case basis.

Charity Tracker

We participate in Charity Tracker. You will receive a follow-up email with a link to complete the Charity Tracker form.
If you do not receive the email, please check your spam folder and then follow up with accounting@gocornerstone.church. Once both forms have been submitted, your application will be reviewed.

I understand that my application WILL NOT be reviewed until the Charity Tracker form has been completed. See notes above. *

Please expect one week to evaluate and process this request once both forms have been completed. Evaluation may require an in-person appointment.

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