Seeds of Security Application for Assistance
from the Benevolence Fund
Applicant Name: *
Your answer
Address (City, State and Zip code) *
Your answer
Telephone Number: *
Your answer
Email: *
Your answer
Statement of Need (Please indicate Amount of Financial Assistance Requested and Indicate What circumstances have created your need) *
Your answer
How long will you need assistance? *
Your answer
How frequently will you need assistance? *
Your answer
Have you received assistance from this fund before? *
If Yes, please indicate the date that you last received funding from SOS.
Your answer
Is this request for $500 or more? If yes, please continue. If no, please click submit. *
Household Monthly Income:
What is the value of your total current assets not including any living necessities such as a house, vehicle, medical equipment, or household furnishings? (Please include cash/checking accounts, savings, CDs, investments, other assets)
What is the value of your total debts? (Please include cash/checking accounts, savings, CDs, investments, other assets)
What options are available to you for support/assistance?
Your answer
What type of assistance, if any, do you currently receive?
Your answer
What other information would you like to communicate to the SOS Team for consideration? (Please attach additional sheets or documentation as appropriate.)
Your answer
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