Benevolence Request Form

We understand that times of hardship can feel overwhelming, and we want you to know that we care deeply about what you’re going through. At King’s Cross Church, we believe that God calls us to love one another in practical ways, and it’s our desire to walk alongside you during this season. As part of that, we may need to ask some questions to better understand your situation and how we can best offer support. Please know that these questions come from a place of compassion, not judgment. Our goal is to serve you with wisdom and care, trusting that God’s grace is sufficient for every need.

Your name *

Email address *

Phone number

Address

Birthdate

Gender

Are you a King's Cross Church partner? *

Yes

Have you previously received financial support from King's Cross Church? *

Yes

How much are you requesting? *

How soon do you need the assistance? *

Current Financial Picture

As part of our desire to walk alongside you in this season, we ask a few basic questions to help us better understand your current financial picture. Our desire is not only to provide financial assistance where possible but also to offer guidance and resources that can help in the long term.

Assets

Current Checking Balance: *

Current Savings Balance: *

Current Retirement Balance: *

Home Equity *

Liabilities

Mortgage Amount: *

Second Mortgage or Home Equity Amount: *

Auto Loan *

Credit Card Debt *

Student Loans *

Any Other Debt *

Budget

In this section, we ask for information about your current budget to help us better understand your financial situation. For each category, please provide both your budgeted amount and your actual expenses.

For example, if you plan to spend $500 per week on groceries but your actual expenses end up being $550, you would write:

Budget: $500
Actual: $550

This information allows us to better assess your needs and offer meaningful support. If you have any questions while filling out this section, please don't hesitate to reach out — we're here to help

Please list all sources of household income and amount of income. *

Charity/Giving: *

Saving: *

Credit Card Payments: *

Please list all

Monthly Rent/Mortgage: *

Please indicate Rent or Mortgage

All other monthly debt payments: *

Please list all

TV / Streaming Services *

Please list all

Internet: *

Cell Phone: *

Gas (for home): *

Electricity: *

Water: *

Trash: *

Auto Loan: *

Groceries: *

Tuition/Education (for yourself): *

Tuition/Education (for family members): *

Daycare *

Kid's Activities (dance, sports, etc.) *

Insurance: *

Please list all (auto, home, health, life, etc.)

Hair Care/ Barber/ Nails etc: *

Gifts: *

Entertainment: *

Other: *

Please list any other monthly expense.

Totals: *

Please list total income minus total expenses

I certify that all information I provided is accurate to the best of my knowledge: *

Name *

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