Application

SECTION I: Tell Us About Yourself

List any additional names you use (maiden name, business name, abbreviated versions of your name, etc.)?

Primary Contact Number*

Age*

Please enter a number from 18 to 100.

How many children at home?

List ages of children at home.*

List ages and relationship.*

SECTION II : TELL US ABOUT YOUR INVOLVEMENT AT VICTORY

Do you attend weekly services at Victory Church?*

Please select the campus you attend.*

How long have you been attending Victory?*

Small Group Leader’s phone Number

What advice did your small group leader give you?

Which ministry or area?

Who did you speak with?

Tell us what has caused this need.*

If no, why not?

If so, how have they been able to help?

Great! When and how did we help?*

If yes, why?

Section III: Your Employment Information

Current employer name*

Current job title*

Current monthly salary*

Previous employer name*

Previous job title*

Previous monthly salary*

How much per week?

How much income do you receive from the source of income you selected above?*

Other sources of income not listed above

Total amount of other income sources

Section IV: Spouse's Employment Information

Spouse current employer name

Spouse job title

Spouse current monthly salary

Spouse previous employer name*

Spouse previous job title*

Spouse previous monthly salary*

How much per week*

Spouse other sources of income not listed above

How much income do you receive from the source of income you selected above?*

Spouse total amount of other income sources

SECTION V: BILLS YOU ARE REQUESTING ASSISTANCE FOR

OUR PRIMARY FOCUS OF ASSISTANCE WILL BE TOWARD PERMANENT HOUSING (RENT OR MORTGAGE), UTILITIES, AUTO-RELATED ISSUES, AND FOOD.

Regardless of the urgency of your request, your application will not be processed until all accompanying documentation is received. Incomplete applications are put on hold until appropriate documentation is received.

HELP US PROCESS YOUR APPLICATION FASTER! In order for us to serve you quickly, please make sure to submit all supporting documents and ID with your application. Then follow these guidelines:

When submitting bills, make sure each bill displays your name, address, and account number. The bill should be dated within the last 30 days and each bill must display the vendors name, address, and current amount due.

Please make sure that the names and addresses on your bills and on your license match the address provided on your application.

If any of the bills are in your spouse’s or family members’ names, they will need to apply separately.

Do not send social security information.

If you pay rent to an individual (landlord), LLC ,LLP or DBA, they must complete and return a signed W-9 Form before your application can be processed.

Regardless of the urgency of your request, your application will not be processed until all accompanying documentation is received. Incomplete applications are put on hold until appropriate documentation is received.

Please note also, that we cannot provide assistance for credit card payments, personal loans, student loans, payments to Title Max, medical bills, alimony and/or child support payments, tuition or legal fees.

How many bills do you need assistance with?*

Bill 1: Company Name/Description/Account No.*

Amount of Bill 1*

Amount Requesting bill 1*

How much of bill 1 do you need assistance with?*

Bill 2: Company Name/Description/Account No.*

Amount of Bill 2*

Amount Requesting bill 2*

How much of bill 2 do you need assistance with?*

Bill 3: Company Name/Description/Account No.*

Amount of Bill 3*

Amount Requesting bill 3*

How much of bill 3 do you need assistance with?*

Bill 4: Company Name/Description/Account No.*

Amount of Bill 4*

Amount Requesting bill 4*

How much of bill 4 do you need assistance with?*

Bill 5: Company Name/Description/Account No.*

Amount of Bill 5*

Amount Requesting bill 5*

How much of bill 5 do you need assistance with?*

Once we have received your documentation (financial assistance form, driver’s license, and copies of all bills for which you are requesting assistance), do not send social security information. Please be patient. Again, due to the volume of applications we receive, processing your request could take up to TWO TO THREE WEEKS. In the meantime, we encourage you to DOWNLOAD THE COMMUNITY RESOURCE GUIDE for more options.

Please Note: Failure to provide all requested information will place your application on hold. It will not be process until we receive all appropriate documents.

Upload up to 5 Bills (acceptable files: jpg, jpeg, pdf, doc, docx, xls, xlsx)

Drop files here or

Accepted file types: jpg, jpeg, pdf, doc, docx, xls, xlsx, Max. file size: 128 MB, Max. files: 5.

ALMOST DONE…

Now that you’ve filled out the application, here’s what you can expect next.

First you will receive an Auto Confirmation email informing you that your application has been submitted

Next our Pastoral Care team will review your application, verify your information in our database and ensure that all supporting documents are in order.

If more information is needed, we will email you to let you know what is still needed to move forward.

Finally, when all your information has been verified, your application will be forwarded to one of our pastors who will call you to discuss your request further.

Please note: Due to the volume of applications we receive, processing your request could take up to TWO TO THREE WEEKS. In the meantime, we encourage you to DOWNLOAD THE COMMUNITY RESOURCE GUIDE for more options.

You are now ready to submit your application!

Remember that our programs offer help to those who are members or regular attenders of Victory and meet most of the following criteria:
•Regular attendance for a minimum of 6 months
•Actively serving within a ministry of Victory Church
•Participation in a Victory small group
•Supports Victory through tithes and offerings

The Information I have submitted is true and correct to the best of my knowledge. (Please provide your initials as your acknowledgement.)*

Name

This field is for validation purposes and should be left unchanged.

What can we help you find?

Financial Help

Financial Assistance Form