3496 Old Weston Road

Buckhannon, WV, 26201

304-460-9160

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Hope Fund Application

*Please fill out this form completely. Our leadership team with connect with you as soon as possible after you submit your form.

Name

First Name

Last Name

Spouse's Name

First Name

Last Name

Phone

(###)

###

####

Please list any dependents with their age. Put N/A if you do not have any dependents.

Briefly describe your situation and why you are seeking financial aid from the church at this time.

Employer

Job Title

Spouse's Employer

Spouse's Job Title

Total Monthly Income

Please list your expenses for: housing, auto, insurance, phone, utilities, other.

Total Expenses

Difference between Income and Expenses