seasonal local outreach

THE CYPRESS GIVING TREE APPLICATION FOR ASSISTANCE

Please fill out this form as completely as possible and submit NO LATER THAN November 7, 2010.  You will then be contacted to schedule a personal interview with Pastor Laurie Hurd.  Interviews will be conducted at the church office during business hours in early/mid November.

Please disregard any difference in color between fill-in boxes.  There is a glitch in the web software that cannot be resolved.  Fill out the application in its entirety.


STEP 1 - Identify who needs assistance

Person(s) in need of assistance

If you are applying for assistance for YOURSELF, please answer the italicized question in STEP 2, then skip to STEP 3


STEP 2 - If you are applying on someone's behalf, YOU MUST complete the following fields (or else we are unable to consider the request).  Also, please be sure to notify the potential recipient of help that you have applied on their behalf in the event they are called to schedule an interview.

Your Name 

Relationship to person/family in need 

Relationship to / involvement with Cypress*

Phone   Email


STEP 3 - Contact information for the person/family in need

Phone**     Email

**(Please be sure to list a phone number that will continually be in service.  If we cannot reach you to schedule the interview, then we will be unable to process the application and offer any assistance.)

Address

City   State    Zip 


STEP 4 - Describe the need

To the best of your ability, please describe the applicant's current situation which would qualify them for assistance

 

Is the applicant currently receiving aid from other sources, either seasonal help or on a daily basis? 
Please explain.

 


STEP 5 - Family information

Please list ALL family members living in the household:

Name   Age   Relationship

Name   Age   Relationship

Name   Age   Relationship

Name   Age   Relationship

Name   Age   Relationship

Name   Age   Relationship

Once the application has been reviewed and considered, the family in need will be contacted by Pastor Laurie Hurd, as mentioned above, to schedule the required personal interview.