Benevolence Request | Pregnancy Help | Pregnancy Clinics Near Me

Benevolence Request

The Benevolence Ministry of the Prestonwood Pregnancy Center was established to minister to the center’s clients experiencing a financial crisis. Any assistance provided is done on a one-time-only basis. Completing the form does not guarantee assistance but might determine if you are eligible to be interviewed by the Benevolence Team. Prestonwood cannot help everyone, and if assistance is denied, we are not obligated to give the reason for denial. Information provided will be kept in strict confidence.

1. Eligibility and Criteria

Clients of Prestonwood Pregnancy Center must complete and sign the form to apply for assistance.
Forms without signatures will not be considered.
Incomplete forms will not be considered.
Financial assistance will be considered for a financial crisis only.

2. Application

Complete and return the application to the Prestonwood Pregnancy Center, who will forward your request to the Benevolence Team. The Benevolence Team will then call you if you do not have “call block” on your phone. If you are using caller ID and monitoring your calls, an attempt to reach you may be announced as “private” or “unavailable” and not “Prestonwood Baptist Church”.

3. If you are invited for an interview:

Applicant and partner, if applicable, should attend together.
Please arrange for childcare, if possible.
You will be asked to provide the bills you would like to have considered for payment.
You will be asked to explain your financial crisis.
The interview team will ask you additional questions about your application.
If you are currently unemployed, please bring your resume and be prepared to discuss your job search.

THIS APPLICATION MUST BE COMPLETELY FILLED OUT IN ORDER TO BE CONSIDERED. PLEASE PRINT AS CLEARLY AS POSSIBLE.

First Name(Required)

Middle Name(Required)

Last Name(Required)

Phone Number(Required)

E-mail Address(Required)

Street Address(Required)

Apartment #

City(Required)

State(Required)

ZIP Code(Required)

Previous Street Address(Required)

Previous Apartment #

Previous City(Required)

Previous State(Required)

Previous ZIP Code(Required)

How long were you at your Previous address (days/months/years)?(Required)

Driver License/ID #(Required)

DL State(Required)

Date of Birth(Required)

Age(Required)

Referred by (agency and/or contact)

Phone

What is the best time to contact you by phone? (Note: If you have “call block” set on your phone, the Benevolence Team will not be able to contact you.)(Required)

Marital Status(Required)

Partner's First Name

Partner's Last Name

Partner's Date of Birth

Total Number in Household(Required)

Please list all individuals living at this address

Name (First and Last)

Date of Birth

Relationship to You

Employed

Name (First and Last)

Date of Birth

Relationship to You

Employed

Name (First and Last)

Date of Birth

Relationship to You

Employed

Name (First and Last)

Date of Birth

Relationship to You

Employed

Name (First and Last)

Date of Birth

Relationship to you

Employed

Your Current Employment

Employment(Required)

Occupation(Required)

Length of Employment (days/month/yrs)

Work Phone

Partner's Current Employment

Employment

Occupation

Length of Employment (days/month/yrs)

Work Phone

Unemployment Information

Partner's Length of Unemployment (days/month/yrs)

Previous Employer

Your Length of Unemployment (days/month/yrs)

Partner's Previous Employer

If unemployed, list jobs for which you have applied below:

Business Name

Date of Application

Business Name

Date of Application

Business Name

Date of Application

Business Name

Date of Application

TYPE OF HELP NEEDED (PLEASE BE PRECISE)(Required)

EXPLANATION OF FINANCIAL CRISIS(Required)

This Month's Take-Home Household Income

Salary/Commission

Partner Income

Other Family Income

Food Stamps

Workers Comp

Unemployment

SSI

Child Care

Other Income

This month's total income(Required)

Total household income earned last year(Required)