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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.

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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

ASSISTANCE:

Food Stamps

WIC

Medicaid

C. Total Assistance:

Unemployment

Other

B. Total Additional Income

1. Total Monthly Income:

(A+B+C)

EXPENSES

FIXED MONTHLY EXPENSES:

VARIABLE MONTHLY EXPENSES (average) :

SAVINGS & GIVING:

Savings

Giving

HOUSING:

Mortgage/Rent

Property Taxes

Association Dues

Home Maintenance

Homeowner's Insurance: 

COMMUNICATIONS:

Cell Phone

Telephone

Long Distance

Internet

UTILITIES:

Electric

Heat

Water/Sewage/Trash

INSURANCE:

Health

Automobile

Life

Other

DEBT REPAYMENT:

Car #1

Car #2

Student Loans

Credit Cards

Other Debts

2.TOTAL FIXED
EXPENSES:

(total items in column)

HOUSEHOLD:

Groceries

Clothing

Household Items

PERSONAL:

Cosmetics

Haircuts

School Costs

PROFESSIONAL CARE:

Dental

Medical

Childcare

Prescriptions

Counseling

ETERTAINMENT:

Cable

Movies/Events

Meals/Eating Out

Vacation

Hobbies

OTHER:

Sports/Fitness

Liquor/Tobacco

Gifts

Gas

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

Savings Account

Money Market Funds

Certificates of Deposit

Mutual Funds Investment

Stocks & Bonds

Primary Residence

Other Real Estate

Insurance

IRA's\Retirement Accounts

Car #1

Car #2

TOTAL ASSETS:

(current balance)

(current balance)

(current balance)

(current balance)

(market value)

(market value)

(cash surrender value)

(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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