Macedonia UMC Community Assistance Form

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All requests will be considered by the Community Assistance Committee and will be responded to in 48-72 hours.

Name *

Age *

Phone Number

Street Address *

City and State *

Email Address

Name and Location of Home Church (if any)

Family *

Single

Married

Divorced

Separated

Widowed

Name, age and relationship of those who are currently living with you on a daily basis *

Current/Most Recent Employer and Occupation *

Are you currently working?

Yes

List what type of financial aid you receive *

Unemployment Insurance

Social Security

Worker's Compensation

Disability

Other

Required

Do you have someone who needs to be paid on your behalf? *

Yes

Required

Name and Phone number of who is requesting payment on your behalf.

Briefly explain the circumstances that brought about this need. *

Do you expect this to be a recurring need? *

I am requesting assistance for... *

I give my permission to have the appropriate church personnel validate any of the above information (write full name and date as a signature). *

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