House of Ruth Benevolence Financial Assistance Questionnaire
This form must be filled out completely for all benevolence requests. Please know that a decision will not be made on the same day as the form is completed and turned in. Please allow a minimum of 48 hours to 1 week to review this application. Incomplete forms will not be processed, so please be as thorough as possible. Information provided by you will be shared with the the Director, the Assistant Director and staff for a determination to be made as a team at our weekly staff meetings. 

*In the meantime, we encourage you to sign up to become a client at House of Ruth. (It's FREE!)

"Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus." Philippians 4: 6-7
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Today's Date:
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Name (first and last)
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Date of Birth
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Phone number
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Home (Living situation)
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Address
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How many people live in your household?
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Marital Status
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Name of spouse or partner
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Number of Children (please include ages)
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Do you attend a local church?
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Are you currently a client at House of Ruth?
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Have you ever received any assistance from House of Ruth in the past? (if yes, please elaborate)
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Are you receiving any other assistance from state or local agencies? If so please list those below. 
(example SNAP, AHCCCS, WIC, Social Security, financial assistance from other organization or church)
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If you applied for support from a local agency/church and were turned down, please explain why?
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Are you currently employed? If yes, please include the name of your employer and how many hours you work.
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Is your spouse/partner currently employed? If yes, please include the name of their employer and how many hours they work.
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Please state your needs in order of importance. "1" being the most urgent need. 
(Example: 1. rent, 2. auto insurance, 3. diapers)
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Explain what circumstances brought about these needs?
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Thank you for the opportunity to serve you. Please be aware that House of Ruth receives many requests and is not able to give financial help to everyone who requests it. We also request that Benevolence 'amounts' received be kept in confidence.

Is there anything else you'd like House of Ruth to know?
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Please read and sign:
I understand that House of Ruth needs 48 hours to1 week to review my application. Applications will be discussed on a weekly basis at our staff meetings. You will be contacted once a decision is made. If you have not heard from us in 10 days please call our office to check on the status. We also encourage you to sign up to be a client in the meantime.

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