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Applicant Information

Name:*

Address:*

Email:*

Phone:*

Statement of Need:

Amount of financial assistance requested:*

What circumstances have created your need?*

Duration of Need:

How long will you need assistance?*

How frequently will you need assistance?*

Details of Need:

Have you received assistance from this fund before?*

Yes

No

If YES, please indicate dates and amounts of assistance:

Will you attend financial counseling?*

Yes

No

(Fill out next section for requests exceeding $200.00)

Summary of Financial Status:

Household monthly income:

Are you currently employed?

Yes

No

Full time

Part time

If employed, name of employer:

If this need is met, how do you anticipate the handling of this expense going forward?

Please list all other individuals sharing your household

VISIT US AT BANKSTON FORK

If you’re looking for a place to feel at home, grow in your faith, or just explore what it means to follow Jesus, we’d love to have you at Bankston Fork Church in Harrisburg, Illinois. No matter who you are or where you’ve been, you’re welcome here—and there’s a seat saved just for you.

Bankston Fork Baptist Church

Connect With Us

First name

Last name

Email

Short answer

618-252-0191

bfbc.joet@gmail.com

5890 OLD HWY 13 W,

Harrisburg, IL 62946

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