Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Spouse's Name (if applicable)
Spouse's Email Address
Please briefly describe any events that have led to this financial constraint (loss of employment, illness, financial management, etc.)
*
Marital Status
Household Members
How many people live in your household? Any children (please include ages)?
Residential Status
Nearest Relative (not living in your household)
Please provide relation and address.
Do you currently attend Christ Church?
*
Yes
No
If yes, how long have you attended Christ Church?
If yes, which campus do you attend?
Central Phoenix
Gilbert
Peoria
If yes, are you a member?
Yes
No
Are you in a small group?
Let us know that name of your current leader, and/or your leader from a past group.
In the past, have you been able to give regular offerings?
Yes
No
Not recently, but have in the past
Are you currently employed?
*
Yes
No
Position
Length of employment
Is your spouse currently employed (if applicable)?
Yes
No
Spouse's Employer
Length of spouse's employment
Total monthly household income
*
Please list any other monthly recurring expenses or any outstanding bills (such as medical bills) including the payee and the amount due.
What is needed?
*
What do you perceive is your greatest financial need? What is needed and how will that help?
Would you like someone to help you evaluate and steward your finances?
Have you already visited City Hope this month?
*
If you haven't visited City Hope, why?
