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Assistance Request Form

Del Aire Baptist Church only assists with short-term and emergency needs. We do not provide long-term or repeated assistance. We will not assist with bills more than 60 days in arrears, child support, medical bills, unsecured loan payments, taxes, legal expenses, or any expense that is not an objective verified need.

Name
Date of Birth
(Very important or the request will not be submitted)
Marital Status:
Current Residence:

Employment

Government Benefits | Investments | Retirement and Pension Income | Rental and Royalty Income | Gifts and Support
List Verified Sources of Income, Including Monthly Amounts:

Assistance Needed

Please select what area the Request is for.
Please include a brief description of your situation, and describe how the requested items will improve your situation?

Please make sure you include the dollar amount needed to process your request.

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera You can upload up to 5 files.
If you are requesting financial assistance, please upload rental agreements, medical bills, utility bills, etc.

If you do not answer this prompt with detail, your request will not be considered.

If you do not answer this prompt with detail, your request will not be considered.

Additional Information

1. Waiting Period

Please allow one week for us to review and verify the information you provided. A member of the DABC Assistance Team will contact you using the information from your application.

Our primary means of contact is by phone. You must provide a telephone number where you can reliably be reached. If we are unable to contact you after two attempts, we will not be able to process your application further.

 

2. Notification and Assistance Policy

Notification will be made by a DABC Assistance Team Member using the primary phone number listed on your application.

If the Assistance Team determines at any point that we cannot provide assistance, you will be notified with the statement: “The Del Aire Baptist Church cannot assist you at this time.” No further information will be given regarding the decision.

Please note: At no point in this process does DABC promise or guarantee that assistance will be provided. All approved assistance will be in the form of a check made out directly to the vendor, landlord, or other service provider—not to the individual applicant. No cash will ever be given.

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