Camarillo Community Church Care Ministry Relationships Matter!

REQUEST FORM FROM THE BENEVOLENCE FUND
CONFIDENTIAL INFORMATION

Please complete the questions on this form. The results will be sent via e-mail to the Benevolence Fund committee. Any request approved will take about three working days to have a check processed. Please note: All checks are made out to businesses that are owed money. No checks are made out to individuals, and no cash is dispensed.

Name*
Street Address *
City*
State*
Zip*
Home Phone*
Work Phone
Cell Phone
Email Address
Marital Status
Number of Children Living at Home
Employer Name
Occupation
1. What is the nature of your request?
2. What is the amount of the request?
3. To whom will the check be made if approved?
4. Do you attend Camarillo Community Church?	Yes No
If yes, about how long?
If no, do you attend another church in our area?
5. Have you been in a Camarillo Community Church Small Group?	Yes No
6. Have you made other requests to Camarillo Community Church Benevolence Fund? If yes, please explain.