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Benevolence Request

Personal Information:

Your name *

Last name

Email address *

Phone number *

Phone type

Address *

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Birthdate *

Marital Status *

Single

Married

Widowed

Separated

Divorced

Other

Are you currently employed? *

Yes

Do you have any children? *

Yes

Church Information

Have you accepted Jesus as your savior? *

Yes

Are you a member of Word of Life? *

Yes

What campus do you mostly attend? *

Bentonville

Siloam Springs

I don't attend Word of Life

Have you attended at least two services a month over the past 3 months? *

Yes

How often do you tithe? *

Often

Sometimes

Never

Referral Information

How did you hear about us? *

Website

Church Service

Friend

Pastor

Social Media

Other

Have you ever applied for assistance from Word of Life before? *

Yes

Have you contacted any other social services or churches? *

Yes

Income/Expenses

Please select all sources of income *

Salary

Hourly

AFDC

Food Stamps

Child Support

Unemployment

Alimony

SSI

Other

Income Total: *

Please select all expenses you have *

Tithe

Housing

Car

Food

Phone

Water

Electric

Natural Gas

Medical

Credit Cards

Internet

Streaming Services

Other

Expenses Total: *

Explain what you are needed assistance with: *

Briefly describe why you need assistance: *

How much are you needing assistance with (please list a dollar amount)? *

Check if assistance is needed in less than two weeks: *

We will do our best to expedite your request; please keep in mind, due do the number of request we receive, importance is based on request order. We do have a two week review process.

I have read and understand the requirements outlined from the previous page and also understand failing to complete requested steps will result in my application delayed or not reviewed. *

Don't forget to submit copies of you bills via email to the office as described in item 3 on the previous page.

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Word of Life
office@wlfar.com
479-273-3460

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