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Bethel Assistance Ministry LT program
PLEASE READ ALL INFORMATION

Bethel only offers help one time per family. This program is NOT for immediate help.

This is a long-term process that takes 6 months or more. If you have received help from Bethel within the past 12 months, you are not eligible for this program until one year has passed.

This application is for families who have already been through Bethel's regular evening BAM process, and are interested in a long-term partnership towards sustainability. This is NOT a program where you will receive immediate help with rent, utilities, etc. This is a program that works with you to overcome barriers and move towards sustainability for your family.

Please complete all information. Your answers are for information purpose only, and will be reviewed with past information you have previously submitted. Your application will be reviewed and you will be contacted about your request for assistance.

This is a long-term (LT) program with a minimum SIX MONTH COMMITMENT to participate, and includes weekly work with an advocate.
Name *
First and last name
Your answer
Name of spouse, partner, or live-in *
Your answer
Address *
Your answer
Email *
Your answer
Cell phone number *
Your answer
Date of birth *
MM
/
DD
/
YYYY
SSN for you and your spouse, partner or live-in (if you don't have one, just answer none) *
Your answer
List the names and birthdates of all who live in your home (excluding yourself) *
Your answer
I need help with: *
Required
I am currently working *
List place of current employment
Your answer
Monthly income sources (for you and/or spouse, partner or live-in) *
Required
List people and agencies (including DSHS and churches) that you have asked for help in the past two years:
Your answer
Have you ever filed for bankruptcy? *
Have you in the past or do you now live at the Union Gospel Mission? *
Have you ever lived in an Oxford House *
Are you a military Veteran? *
Have you ever participated in an addiction recovery program? *
Do you currently attend church? If yes, what church?
Your answer
I declare the information I have provided is true, correct and complete to the best of my knowledge. I hereby give my express consent to BETHEL CHURCH to verify my information and to share it with relevant staff and volunteers and to enter my information into Charity Tracker (Tri-Cities Network). I release Bethel Church from any and all liability and understand that assistance may be withheld for incomplete or misinformation on the application or during the interview. *
Electronic Signature (please type your name below): *
Your answer
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