Assistance Request Form

The Assistance Fund is a limited financial fund, made available by application to people of the Our Savior Lutheran Church community who are struggling financially. The money, intended to provide one-time and short-term relief for food, shelter, and utilities, is granted as a gift, and repayment is not expected. However, if you are blessed in the future and would like to help someone else, you donate to the fund and it will be used to help someone else in need.

All information provided to the Assistance Team will be kept as private as possible. Please be honest and open in responding to the questions.

All applications must be fully completed and are subject to a review and approval process. Once an application is received, our Assistance Team will contact you to review your application. If your request is approved, it may take up to 2 weeks to receive funding. No funding will be given directly to the applicant, but to the company where the amount is needed.

Your name *

Email address *

Phone number *

Applicant's name *

Address

How are you connected at OSLC? *

What is the total amount you are requesting? *

What will this financial assistance be used towards? *

Briefly explain the situation that has led to you apply for this assistance. *

Email Documentation *

To complete your application and for it to be considered, you are required to submit a digital upload (photo, pdf, etc.) via email to nora@oslc.com with the subject "Benevolence Documentation - Your Last Name" prior to consideration.

By checking this box, you acknowledge that you understand and agree to electronically submit this documentation.

Who referred you to apply for financial assistance? *

Authorization *

I hereby authorize the release of information to OSLC to receive the assistance I am requesting. I further certify the information I have stated is true and correct and that all income is reported. I understand OSLC may verify the information on this application and that deliberate misrepresentation of information may subject me to denial of assistance/services.

I give permission for OSLC to discuss my case with other agencies, businesses, churches, attorneys, individuals, and any others deemed necessary to verify application information and/or identify additional sources of assistance. I understand that all information will remain as private as possible within these entities.

I have read, understood, and agree to the policies above regard the Release of Information. If you agree to these terms, please write your full name below as a signature.

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