FINANCE // Financial Assistance

Name

Address

Phone

This address will receive a confirmation email

Date of Birth // Age

Financial Assistance Request

At Wellspring Church, we believe in caring for people through both practical support and biblical stewardship. Financial assistance may be available for individuals and families who consider Wellspring their church home, have completed the Wellspring Connect process, have been actively involved for at least six months, and are faithfully participating in the life of the church.

Each request is prayerfully reviewed on a case-by-case basis and may take up to three weeks to process. Financial assistance is intended to provide temporary support during genuine hardships and is generally limited to one request within a 12-month period unless exceptional circumstances exist.

Some areas we have been able to assist with in the past include:

Water bills

Electric bills

Grocery assistance or food resources

Connections to local food banks, clothing resources, and community support services

Some areas we are generally not equipped to assist with include:

Past-due rent or mortgage payments

Legal expenses

Cable, streaming, or entertainment services

Please Note: Submission of this form does not guarantee that financial assistance will be provided.

Our Heart for Care

At Wellspring Church, care extends beyond meeting immediate needs. Through pastoral care, prayer, discipleship, community, and practical support, our desire is to walk alongside people during difficult seasons while encouraging spiritual growth, health, and wise stewardship.

After your request has been reviewed, a member of our team may contact you for an initial care conversation. Based on your situation, we may recommend a personalized care plan that includes pastoral support, prayer, discipleship resources, financial stewardship guidance, or connections to additional community resources.

Our goal is not simply to provide temporary relief, but to help people encounter God's faithfulness, experience healthy growth, and move toward lasting stability and restoration.

I Am

Single Married Separated Divorced Widowed

Do you have children?

Yes No

If you have children, how many children do you have? 1 2 3 4 5+

Please provide the first name and age of any minor children who are living with you.

Are any of your children 18 or older? Yes No

Please provide the name, age, and contact number of all your adult children.

Are you or your spouse currently employed?

Yes No

If yes, what is the name of the company you are employed at?

Please provide the number of your employer.

Please provide the name of your manager or oversight.

What is the name of the company your spouse is employed at?

Please provide the number of your spouses employer.

Please provide the name of your spouses manager or oversight.

Are you currently attending Wellspring Church?

Yes No

If you are not currently attending a church, please explain why.

What kind of assistance are you seeking?

Funds Food Clothing

Briefly explain what brought you to these circumstances.

Please provide any other places you have gone for assistance.

Please check all of the financial assistance you are receiving from a government agency. Unemployment Social Security Workers Compensation Disability Other

Are you willing to confidentially meet with our Benevolent committee?

Yes No

Do you give consent to have the appropriate church personnel to verify any of the above information?

Yes No

By checking this box, I am acknowleding that all information is true and I am consenting to have the information I provided to be verified .

I consent I do not consent

FINANCE // Financial Assistance

Financial Assistance Request

Our Heart for Care

Description

Please Fix the Following