Helps Ministry Initial Contact Form | Victory Baptist Church of Montrose

Initial Contact Form

VBC Helps Ministry exists to exalt God through the stewardship of VBC's charitable funds to edify the saints and evangelize the lost. VBC Helps Ministry will protect the privacy of your information with the exception of those with a need to know in order to confirm the information provided or to determine the resolution of the request. Please fill out the following form thoroughly to enable us to understand your need and know how to serve you.

Name (Required)

Email Address (Required)

Your Phone Number (Required)

Your Address (Required)

Age (Required)

Are you willing to interview with the VBC Helps Ministry regarding your current need? (Required)

Marital Status: (Required)

Single

Married

Divorced

Separated

Widowed

Engaged / Dating

Dependents

Dependent A--(Last,First)

Dependent A -- Age

Dependent A -- Relationship

Dependent B -- Name (Last, First)

Dependent B -- Age

Dependent B -- Relationship

Dependent C -- Name (Last, First)

Dependent C -- Age

Dependent C -- Relationship

Dependent D -- Name (Last, First)

Dependent D -- Age

Dependent D -- Relationship

Dependent E -- Name (Last, First)

Dependent E -- Age

Dependent E -- Relationship

How Would You Describe Your Relationship with God? (Required)

Name and Address of Home Church:

Are you a member of the above Church? (Required)

Employment History:

Are you currently employed? (Required)

Current Employer:

Current Employer Contact Person

Current Employer Phone Number:

Previous Employer Name:

Previous Employer Contact Person:

Previous Employer Phone Number:

Previous Employer Name:

Previous Employer Contact Person:

Previous Employer Phone Number:

If not currently employed, are you seeking employment?

If yes, with whom are seeking employment?

Potential Employer Name:

Potential Employer Contact Person:

Potential Employer Phone Number:

Potential Employer Name:

Potential Employer Contact Person:

Potential Employer Phone Number:

Current Sources of Income:

Current Sources of Income/Helps (check all that apply)

Unemployment

Social Security

Worker's Compensation

Disability

Medicaid

Other

If "other" please explain

References:

Include references not listed in employment history

Reference #1 -- Name: (Required)

Reference #1 -- Relationship: (Required)

Reference #1 -- Phone: (Required)

Reference #2 Name

Reference #2 Relationship

Reference #2 Phone

Reference #3 Name

Reference #3 Relationship

Reference #3 Phone

Please list family members who are able to help you.

Family member #1 Name

Family member #1 Relationship

Family Member #1 Phone

Family member #2 Name

Family Member #2 Relationship

Family Member #2 Phone

Family member #3 Name

Family member #3 Relationship

Family member #3 Phone

Family Member #4 Name

Family Member #4 Relationship

Family Member #4 Phone

Where all have you gone for financial assistance in the last year and how much have your received? (Required)

Briefly explain your current need and the circumstances of the need.

Please have the following forms ready when you meet with a member of the Helps Ministry.

Copies of current bills with vendor name and contact information included

Current Bank Statements

3 months of CC statements

Current budget if applicable

Amount of current need? (Required)

Victory Baptist Church of Montrose

2890 N Townsend Ave
Montrose, Co 81401

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