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HBC BENEVOLENCE APPLICATION

Here at Harvest we want to help. And to help those in need, we have created a way to wisely distribute funds to those who genuinely need it. 

To apply for financial help please submit the Benevolence Application. That can be done by downloading the PDF, printing, and filling out a hard copy. Or by filling out the form below and submitting it.

**Please note that we cannot fully process your application if it is not filled out to the fullest extent. 

PDF Application Submission

Step 1: Download HBC Benevolence Application.

Step 2: Fill out the entirety of HBC Benevolence Application, and send it to the address in Step 3.

• Digitally: You can do this through a PDF filler on your device, or you can do it online here. 

• Hard Copy: If you want to mail in your application, you can print the PDF at home. If you don't have a home printer, you can utilize a printer at a local library at no cost. If you are unable to print the PDF application, you may request a paper copy by filling out this short form, and we will send you a paper copy via mail service. 

Upload PDF Application Here

Step 3: 

Upload HBC Benevolence Application to this button.

OR

Send by mail to:

Benevolence Team

224 Harvest Lane

Natrona Heights, PA 15065

Online Benevolence Application

Online Application Submission

Step 1: Fill out HBC Benevolence Application in its entirety.

Step 2: Press the Submit button, and your online application will automatically be sent to our benevolence team.

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Benevolence Application

TELL US ABOUT YOU

DATE:

Marital Status:
Preferred Method of Contact

Name & Ages of People Living With You (include adults and children):

Where do you work and what is your occupation?

Level of Education (include any business, trade, or vocational schools you attended): 

How long have you attended Harvest Baptist Church?

What groups or ministries are you involved in at HBC? (Please note the length of time you have been involved.)

Do you participate in a small group?

If yes, who is you small group leader?

CURRENT SITUATION

EMOTIONAL, PHYSICAL, RELATIONAL & SPIRITUAL

GROWTH AND SPIRITUAL DEVELOPMENT

FINANCIAL

Is your family aware of your financial need?

BUDGET AND NET WORTH

On the next section with of this application is a monthly budget worksheet. This is a very helpful tool in organizing your thoughts about the way that money comes in and goes out of your household. In addition, there is a net worth worksheet that will assist you in organizing what you own (assets) and what you owe (debt) at the current moment.

Please complete both of these worksheets as completely and as accurately to the best of your ability and include these worksheets with the submission of your application. We may also ask for a copy of last year’s Income Tax Return Form (Form 1040) to supplement the information on your application.

MONTHLY BUDGET WORKSHEET

WHAT COMES IN AND HOW IT GOES OUT

DATE:

INCOME

A. Total Monthly Take-Home Pay:

ADDITIONAL INCOME:

Social Security

Retirement

Spouse/Child Support

Interest Earned

Unemployment

Other

B. Total Additional Income

ASSISTANCE:

Food Stamps

WIC

Medicaid

C. Total Assistance:

1. Total Monthly Income:

(A+B+C)

EXPENSES

FIXED MONTHLY EXPENSES:

SAVINGS & GIVING:

Savings

VARIABLE MONTHLY EXPENSES (average) :

HOUSEHOLD:

Groceries

Giving

Clothing

HOUSING:

Mortgage/Rent

Household Items

Property Taxes

Association Dues

PERSONAL:

Cosmetics

Home Maintenance

Haircuts

Homeowner's Insurance: 

School Costs

COMMUNICATIONS:

Cell Phone

Telephone

Long Distance

Internet

UTILITIES:

Electric

Heat

Water/Sewage/Trash

PROFESSIONAL CARE:

Dental

Medical

Childcare

Prescriptions

Counseling

INSURANCE:

Health

ETERTAINMENT:

Cable

Automobile

Movies/Events

Life

Meals/Eating Out

Other

Vacation

DEBT REPAYMENT:

Car #1

Hobbies

Car #2

Student Loans

OTHER:

Sports/Fitness

Credit Cards

Liquor/Tobacco

Other Debts

Gifts

2.TOTAL FIXED
EXPENSES:

Gas

(total items in column)

3. TOTAL VARIABLE
EXPENSES:

WORKSHEET SUMMARY:

(copy totals from above)

Total Income:

2. Total Fixed Expenses

3. Total Variable Expenses

THE BOTTOM LINE =

NOTE:

Please fill out this form as completely as possible AND calculate your “BOTTOM LINE” by subtracting your total fixed and total variable expenses from your total income.

NET WORTH WORKSHEET:

WHAT YOU OWN AND WHAT YOU OWE

ASSETS (WHAT YOU OWE):

(current values)

Checking Account

(current balance)

Savings Account

(current balance)

Money Market Funds

(current balance)

Certificates of Deposit

(current balance)

Mutual Funds Investment

Stocks & Bonds

(market value)

Primary Residence

(market value)

Other Real Estate

(cash surrender value)

Insurance

IRA's\Retirement Accounts

Car #1

Car #2

TOTAL ASSETS:

(total items in column)

DEBT (WHAT YOU OWE):

(current balance due)

Mortgage

Car #1 Loan

Car #2 Loan

Home Equity Loan

Department Store Credit Cards (list):

Other Credit Cards (list):

Student Loans

Delinquent Taxes

(IRS, state, local, etc.)

Other Debt (list):

TOTAL DEBT:

(total items in column)

WORKSHEET SUMMARY:

(copy totals from above)

Total Assets

Total Debt

THE BOTTOM LINE =

(TOTAL ASSETS MINUS TOTAL DEBT)

Thanks for submitting!

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