Assistance Application

Please complete all information below and allow up to one week for processing. Incomplete or missing information will delay our processing/response.

Applicant NameEmail AddressDate of Birth

Address

How long at this address?Rent?own?Marital status
‍MARRIEDSINGLEDIVORCEDSEPARATEDHome PHONEWORK PHONE CELL PHONEDRIVER LICENSE NUMBERPlease list names, ages, and relationship of all individuals at this address including yourself:WHAT CHURCH DO YOU ATTEND?DO YOU REGULARLY TITHE ON YOUR INCOME?IF SO, WHERE DO YOU GIVE YOUR TITHE?CURRENT EMPLOYER & HOW LONG EMPLOYED?SPOUSE'S EMPLOYER & HOW LONG EMPLOYED?IF UNEMPLOYED, HOW LONG & REASON FOR UNEMPLOYMENT?HOW ARE YOU SEEKING EMPLOYMENT?WHAT ARE THE CIRCUMSTANCES THAT LED YOU TO THIS REQUEST FOR ASSISTANCE?Please list what you are asking the church to pay. Copies of the bills must be sent via email to info@destinyokc.com with the address, your name (or account holder if it's not under your name), and account number clearly visible." ALL PAYMENTS ARE MADE DIRECTLY TO THE SPECIFIC VENDORHOW WILL YOU MEET THESE NEEDS IN THE FUTURE?HAVE YOU ASKED FOR ASSISTANCE FROM OUR CHURCH BEFORE?IF YES, WHAT WAS THE REQUEST AND WHEN?ARE YOU RELATED TO ANY CHURCH STAFF, BOARD MEMBER, OR KEY CONTRIBUTOR?PLEASE LIST TWO CONTACTS WHO CAN CONFIRM THIS INFORMATIONPlease provide information on your current monthly income sources and all expenses by type (you may email us a list/spreadsheet or list information here):I CERTIFY ALL INFORMATION IS ACCURATE AND I AUTHORIZE DESTINY CHRISTIAN CENTER TO VERIFY ALL INFORMATION PROVIDED.Submit

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