Financial Need

First Name

Last Name

Campus

Mobile Phone

Birthdate

Marital Status

If married, spouse's name

How long have you been attending The Crossing?

Are you in a Small Group?

Yes No

If yes, who is your leader?

What ministries have been involved in at The Crossing?

Have you received assistance from The Crossing in the past?

Yes No

What is your total family income for the month?

Are you employed?

Yes No

If yes, who is your employer?

Are you currently receiving assistance from any other source?

Yes No

If yes, please give source of assistance and amount/type of assistance you are receiving.

Tell us About What's Going on and How We MIght Help

I agree that the information I have provided is true to the best of my knowledge. The church has permission to verify any of the information to help in determining my request for assistance.

I release The Crossing, its employees, agents or other persons, and organizations on its behalf, from any liability out of, or resulting from this application.

Electronic Signature

Today's Date

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