Mercy Ministry Request
Please complete the following information so that your needs are properly routed to the right resource of service. If you need assistance completing this form, please contact Please attach or send any supporting financial documents to

All questions must be answered. If you find that a question does not apply, you may answer N/A (not applicable)

Section 1 is to be completed by all applicants.

Section 2 is to be completed by or for the individual making request.

Section 3 only needs to be completed by an individual making a referral.

Section 4 only needs to be completed by those making a financial request.

Section 5 is for office use only.

Email address *
SECTION 1- Please read thoroughly before completing this form.
We enjoy coming alongside people who find that some of life's difficulties are beyond their personal resources. It happens to all of us at some point.

The good news of the finished work of Jesus compels our church to take extra special care of our family members at Grace Mills River as well as others who ask for our assistance. In fact, those of us serving in mercy and diaconate ministries feel that our primary calling and passion is to express the love of Jesus by offering or connecting people to all sorts of resources available to them.

We believe there is a biblical basis for seeking assistance from the following sources before seeking assistance from churches that you do not attend or are not a member.

FIRST, we would like for you to communicate your situation and your needs to your family, both immediate and extended before seeking assistance from other sources.

SECOND, If you have a home church other than Grace Mills River, we also ask that you find what assistance is available through them. We will contact the church of which you are a member or attend regularly.

Only fill out the Sections which apply to you and your needs. Remember, an incomplete form may slow the application process. Also, please email any documents that you feel would be helpful in reviewing your request to

[If you are an active member of Grace Mills River please proceed to the next question. If you are not an active member of Grace Mills River, please continue reading]
Third, we would like for you to seek assistance from the non-profit social service agencies that specialize and have greater resources than we do as a church.

Grace Mills River gives regularly to such ministries as Interfaith Ministries, IAM, Sharing House, and ABCCM so that these non-profit organizations can distribute the appropriate aid as needed. These, and other organizations like them, have resources, personnel and skills which we do not have available through our church. Their employees and volunteers have the passion, calling and training to assist in times of need and crisis.

Please call 211, which is a directory assistance hotline available 24/7 for community service information. They can help you find the specific assistance that you need in a much more timely way than we are capable of doing through our church. They will connect you to agencies that can help with food, rent, fuel, utilities, and clothing for adults and children.

FOURTH, If you are unable to find assistance from the above sources, our deacons at Grace will respond to your completed request once assess what help or referrals we may be able to offer.

Please keep in mind that our church office staff are not responsible for distributing, discussing or influencing in any way what assistance may be available. Office staff also cannot discuss the details of your needs. Please be courteous about their time by completing this form electronically or taking the form off campus to thoroughly complete it. Please attach any documents that you feel would be helpful to our deacons as they review your request.

Please be patient. Since we are a church and not an assistance agency, it takes time for us to process your request, maybe up to 2 weeks. We can make no provision for immediate assistance. For more immediate assistance call 211.

To help us best respond to your request, please thoroughly complete the following information so that your needs are properly routed to the most helpful resources.

We cannot guarantee that we will be able to fulfill your request however, we are happy to assist you in finding the resources and/or services you need.

Please be aware that those who will be assisting are mostly working people with full lives and are volunteering their time, skills and energy. We cannot guarantee that we can provide the service you are requesting in the time frame that you prefer. The time needed to process your request will be determined by the one(s) providing the service.

Please do not ask or expect the individual(s) who will be helping you to do other tasks that are not mentioned in this request. If you need additional services not described in your request, please complete a separate MMR.

If you have several tasks that you need assistance with or if your need is ongoing, indicate that in the descriptions below and understand that different individuals may be serving in each task. We may be able to provide service in some areas of need and not in other areas. All of the services provided will have an end date.

Only complete the Sections which apply to you and your needs. In the sections you complete, remember, incomplete responses may slow the application process. Also, please email or attach any documents that you feel would be helpful in reviewing your request to

Our church office staff and church leaders keep all of your information confidential. Also, we will do our best to help you in a timely manner. Please let us know how and when to best communicate with you. You will be contacted once this form is completed, received and reviewed. If you need immediate assistance, call 211

Grace & Peace,
The Diaconate of Grace Mills River

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