Assistance Request Form
Welcome to our online assistance request form. Many of us are struggling right now, in a variety of ways. Members of the Foothills United Methodist Church are committed to doing what they can to offer support and care to our larger community during this time. The funding for this assistance fund is one of the ways our congregation is seeking to do that. Please understand that we have certain protocols that we must follow to be good stewards of the donations people have entrusted us with, and that the limitation of our resources might not allow us to help in every situation. Please know that your requests for assistance will be handled with the utmost discretion and care.

1. Complete this form as accurately as possible.
2. You will need to provide a copy of the bill you need assistance with AND a copy of your photo ID. Email the documents to Without these documents, your application is incomplete and cannot be reviewed. You can use your phone as a scanner by using a scanning app; do not take a photo of your documents in camera mode. If you do not have the ability to send this documentation digitally, you can mail it to us at 3301 Green Valley Road, Rescue CA 95672. At this time our staff is not on-site to accept this information from you in person, so please email or mail.
3. You will receive a phone call from a church representative to discuss your situation after your documents and assistance request form have been received.
4. On average, you should expect up to 5 business days for us to fully process your request upon receipt of all required documentation.

We typically provide assistance for the following needs: basic utilities such as water, electricity, natural gas/heat, etc., rent/mortgage assistance, vehicle repairs, prescription medications. Assistance funds are for the purpose of helping meet essential needs, administrators of the Foothills UMC assistance fund will determine if your request meets that threshold. Unfortunately, we CAN NOT assist with motel/hotel stays or gas cards.

Any checks issued will be made out to the service provider (utility, landlord, etc.). We do verify the bill with the service provider. We do not give cash assistance, or make assistance checks payable directly to you. We are not able to provide assistance on your behalf to landlords that you are related to or other tenants who sublet to you.
Email *
Name *
Other Names Known by (nicknames, maiden name)
Total number of people living at your residence?
Names of other adults in household
Number of children under age 18 in household?
Address (Street, City, State, Zip)
Phone Number
What are you requesting assistance with?
Amount requesting:
Total amount due:
Does any of the total bill include late fees?
Clear selection
If there are late fees, how much?
Service Provider/ Landlord Name of the bill assistance is requested for. (A copy of this bill should sent in via email. See instructions above.)
Check Payable to (must be written to service provider):
Service Provider/ Landlord Phone Number
Are you currently employed?
Clear selection
Have you ever received financial assistance from Foothills United Methodist Church before? If so, how long ago? What were the circumstances?
Is your current need for assistance related to the coronavirus pandemic?
Clear selection
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