COR Church Benevolence 
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First & Last Name *
Address  *
Phone number  *
Email  *
Gender *

Age
 *
Marital status *
Do you attend COR Church? *
Purpose of request? *
Have you requested help from COR Church in the past? *
What steps are you taking to improve your present situation?
 *
Have you contacted anyone else for assistance within the last 12 months?
 *
What events led to your needing assistance?
 *
How long have you been unemployed?
 *
What steps are you taking to seek active employment?
 *
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