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Request for Pastoral Assistance
from Wesley United Methodist Church
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Email
*
Your email
Name
*
Your answer
Email
*
Your answer
What do you need assistance for, specifically, and for what amount?
*
Your answer
What is today's date?
*
Your answer
Full mailing address
*
Your answer
Phone number
*
Your answer
Have you applied for other assistance?
*
Yes
No
What agencies have you applied to and when?
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Your answer
What is your source of income?
*
Full-time job
Part-time job
Social Security
Social Security Disability
How much income do you receive each month?
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Your answer
How many adults live with you?
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Your answer
How many children live with you?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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