Financial Assistance Request

Financial Assistance Request Form

The People Helping People (PHP) fund of Westover Church allows us to generously meet urgent needs among those in our church and our community. Qualifying needs for consideration for assistance include, but are not limited to housing, utilities, transportation, food, healthcare/medical, childcare, scholarships, and bereavement. While we are committed to doing everything possible to help in a way that promotes dignity and financial sustainability, there are limitations with what we can do, how quickly we can respond, and how much we can provide. Therefore, Westover Church reserves the right to decline requests for any reason. Please allow 1-2 weeks for your request to be processed.

Please complete the following information to the best of your ability.

Full Name *

Date *

Address *

Phone *

Email Address *

Preferred Contact Method *

Phone Call

Text

Are you a member or attender of Westover Church? *

Yes

If YES, which best describes your attendance with Westover?

Frequent

Occasional

Seldom

Never

If NO, are you a member of, or attend, another church?

Yes

Which church?

Please describe your need. What circumstances led you to request assistance, and how you are requesting Westover Church to help? Please be specific. *

Please share the total amount you are requesting, including the name of the business(es) where payment is due.
NOTE: Any payments issued will be made directly on your behalf. Westover Church cannot provide cash, issue personal checks, nor reimburse for payments already made. *

Please attach electronic copies of bills, statements, invoices, ledgers. Additionally, these items can be sent to php@westoverchurch.com or mailed to us 505 Muirs Chapel Rd., Greensboro) or dropped off at the front desk during office hours.

Were you referred to Westover? if so, who referred you? *

Have you contacted any other organizations/churches for assistance with the need(s) described above? *

Yes

If YES, please list those you have recently contacted:

Are you currently receiving any other form of assistance such as SNAP (food stamps), Medicaid, Medicare, Social- Security, or Disability? *

Yes

Are you currently employed? *

Yes (full-time)

Yes (part-time)

If YES, Name of Employer

Is anyone else in your household employed? *

Yes (full-time)

Yes (part-time)

Total number of people in your household *

Total weekly household income *

Would you be willing to meet with someone to help develop a financial plan and receive coaching. *

Yes

Your signature below indicates that you have read and understand Westover Church’s People Helping People policy above, and that the information provided is true and completed to the best of your ability. Also, by signing, you agree to be available for a follow-up conversation with a Westover team member. All information provided is held strictly confidential. Furthermore, your signature authorizes Westover to contact parties mentioned above only as necessary.

clear

Questions? Please contact us at php@westoverchurch.com.