Benevolence Request Form

Bethel AME Church is committed to supporting individuals and families facing urgent physical needs. Please complete this confidential form to request assistance for food, clothing, or housing. A team member will contact you within 72 hours. Completion of this form does not guarantee assistance.

Your name *

Last name

Email address *

Section 1: Personal Information

Phone number *

Phone type

Address *

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

* Are you an active member of Bethel AME Church? (Required) *

Yes

Community Request

Section 2: Assistance Details

Type of Assistance Requested (Required) *

Food Assistance (Emergency Food Pantry)

Clothing Assistance (Church Clothing Closet)

Housing Assistance (Rent/Eviction Prevention or Shelter Referral)

Utility Bill

Transportation

Other (Please Specify Below)

If you selected Other, please describe:

Amount Requested *

min: 1 / max: 250

Have you previously received benevolence assistance from Bethel AME Church? *

Yes

If yes, please enter the date of your last assistance:

Section 3: Reason for Request *

Please provide a detailed explanation of your current situation and reason for your request. Supporting documentation will be required.

Section 4: Upload Supporting Documents

Please upload the following:
* A copy of your Photo ID
* Supporting documents (e.g., utility bills, eviction notices, rent statements)

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Section 5: Other Assistance

Have you applied for assistance from any other agencies or organizations? If yes, please list their names and the outcome.

Section 6: Authorization Agreement *

By submitting this form, I certify that all information provided is accurate to the best of my knowledge. I understand that submission does not guarantee approval and that assistance is subject to church resources and Benevolence Committee review.

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Bethel AME Church Mobile
bethelamechurchmobile9@gmail.com
251.206.0013

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