Benevolence Application

Dear Applicant,
Thank you for your interest in the Crossroad’s Benevolence Fund. We are sorry for the situation you currently find yourself in which is causing the extra burden of financial strain.

Here are a few clarifications for the fund to help you determine if we may be able to help you.

- The fund exists to assist regular attendees of Crossroads Church Peosta.
- There is an application process (see below).
- This fund is not designed for immediate assistance. Decisions are typically made between seven (7) and twenty-eight (28) days
- Types of need considered: Medical, rent/mortgage, moving expenses, utilities, transportation
needs, funeral expenses, counseling and other quantifiable needs as determined by the team.
Credit card bills are not eligible. Cash is never provided, and checks are never paid directly to the applicant/recipient.

Application Process:
1) Complete Section One.
2) Complete Section Two IF you are requesting more than $1000, or you have applied to this fund any time previously.
3) Provide a cover letter (see examples below).
4) Provide copies of receipts, invoices, rental agreements, etc. for which assistance is being
requested with the exception of counseling requests. See notes below on counseling.


Please note the above steps are required. The Benevolence Team may also ask to meet with an applicant for additional questions and may also request further documentation to help make a determination.

Confidentiality:
The Benevolence Team operates confidentially and members are those who have shown integrity in this area. Questions for a determination may also need to be directed to a pastor, staff, mentor or community group leader. If conversations would be needed beyond this group of individuals, someone from the benevolence team would contact the applicant for permission.

Counseling Application:
If you are applying for counseling, follow the same application process listed above aside from step four. You will skip step four (4) as your bill (if approved) would be paid post-counseling.
The Benevolence Fund provides counseling for six (6) sessions. We recognize that needs vary, and applicants may need a much more extended treatment. The fund is designed to help absorb some of the financial impact and provides some extra time to allow the applicant to make a plan about ways to cover future expenses. For some applicants, a few sessions will be sufficient. The fund also only covers counselors which have been pre-approved by Crossroads.

All recipients will still be responsible for $25 per visit. Crossroads then covers the remainder. The recipient will still receive an auto generated bill from the facility for the remaining balance, but this will not need to be paid until all approved treatments are done. At the time of completion of the approved visits, the Benevolence Team is notified by the counselor/facility and payment is completed by Crossroads. (If you are approved for counseling, and have additional questions at that time about the billing, a liaison from the team can provide further explanation).

Cover Letter for Step Three of the Application Process:
This letter should briefly explain how the need came to be, how the assistance will help, and also explain your future financial outlook and plans.

Examples-
Dear Benevolence Team,
I am a recent college graduate. I had a summer internship lined up, but due to the changing economic environment the company had to eliminate the position. I am working as a waiter and searching for work in my field, but my car has broken down. The repair is $600, and I do not currently have those funds. I am seeking assistance as I need transportation. I am planning to put away $100 a month towards a $1000 emergency savings, but I only have $200 saved so far from work in June and July. My car is fairly reliable so I don’t forsee another unexpected need in the next year. Assistance to help during this transition would be helpful and most appreciated.
Sincerely,
"Y”



Or


Dear Benevolence Team,
I am a single parent. One of my children has incurred multiple medical bills. I owe $1500 right now and because of her health situation I have only been able to work 30 hours/week for the last two months. I have been taking her to appointments, stayed with her at the hospital and have had to pay a babysitter occasionally to watch my other child. I have been working on trying to find a better job that is not hourly and provides a better salary and benefits. I have applications in at three businesses now. In the meantime, I could really use some help with the medical bills.
Sincerely,
"X”

Both of the above examples address how the need occurred, why some assistance might be necessary and how the person is planning to make any needed financial adjustments for the future.

Extra Requirements:
Approved applicants may on occasion be asked to take follow up steps such as joining a Crossroads Community Group (if not already participating), taking a financial planning class, or meeting with someone from the Team for general follow up on progress.

“It is more blessed to give than to receive.” Acts 20:35b

Thank you again for your interest in the fund. We understand and appreciate that it is humbling to ask for help, but we desire to be a blessing in this way whenever possible. If you have further questions, direct them to a pastor or your community group leader, and they will contact one of the team members on your behalf.

Blessings,
The Benevolence Fund Team

Section One: Applicant Information

Please be as specific as possible and follow this example to indicate what needs you are requesting assistance for.
Example: $50 for water bill

Section Two: Budget

Please complete if you are requesting $1000 or more and/or you've requested assistance from the fund previously.
Budgets can be sent to benevolence@crossroadspeosta.org

Job #1 (actual take home pay)

Job #2 (actual take home pay)

Job #1 (actual take home pay)

Job #2 (actual take home pay)

Monthly Expenses

Total Monthly Expenses: this is the total of the following 47 questions

Please provide your cover letter here.

Section 4: FOR ADMIN USE ONLY

Date
Date

Please use the following format: $_____ for _____ to payee _____

By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

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