Marital status *
Select… Single Married Widowed
Household members
+ Add adult + Add child How long have you been attending City Light? *
Small Group Leaders and/or Team Leaders *
If applicable, please tell us the name(s) of your small group leader and/or team leader.
Have you received benevolence assistance from City Light before? *
If yes, please describe what was provided and when.
Explain your current situation and what led to this need. *
What type of assistance are you requesting?
(Check all that apply)
Who should the assistance be paid to? (Include name, business, and account # if applicable)
We do not give
Will this assistance resolve the issue, or is this part of an ongoing need? *
Are you currently employed? *
Monthly Household Income *
Upload a copy of your ID *
Choose 1 file. Maximum file size 10 MB.
Upload bill, invoice, or documentation of financial need *
(Utility bill, rental statement, medical bill, etc.)
Add up to 5 files. Maximum file size 10 MB.
Upload any proof of emergency *
(Termination letter, medical paperwork, etc.)
Add up to 5 files. Maximum file size 10 MB.
• I understand that benevolence is for short-term emergencies.
• I give City Light permission to review this information and follow up with me.
• I understand City Light may not be able to fulfill my full request.
• I commit to a follow-up meeting or phone call if assistance is provided.
Submit
