Family Need Applicatiom Form
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1STERLING BEREAN CHURCH
FAMILY NEED APPLICATION
Prov. 11:14 “Where there is no counsel, the people fall:
but in the multitude or counselors there is safety.” NKJ
Date:
_________________________________
Name:
______________________________________________
Email: ______________________________
Address: _______________________________________________
Phone: ______________________________
Description of need:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Do you want this Local church body to help you with your need?
Yes
No. If “Yes”, the following will apply:
EXPECTATIONS
Berean Church’s Expectations of Individual _
Individual’s Expectations of Berean Church _____
1. Follow counsel of another counselor
1. Shepherd Individual’s need through Counselor
2. Attend small group/personal accountability
2. Provide care and accountability/Counselor
3. Attend church faithfully/daily quiet time
3. Counselor or Small Group to teach Biblical responsibility
4. Meet with financial/spiritual counselor
4. Provide Spiritual/Financial counseling
Do you agree to these terms? Yes
No.
(If “yes”, proceed with interview. If “no”- help will be limited or none)
INTERVIEW
1.
Are you a member of Sterling Berean church?
Yes
No
If “no”, how often do you attend ? _____________
2.
Do your relatives know about your need & are they willing to help?
Yes
No
3.
Do you think you need to meet with a financial counselor?
Yes
No
Why? __________________________
(If possible, individual should take class relating to financial management offered by church)
4.
Are you currently involved in a Small Group?
Yes
No ( attendance will be confirmed by interviewer)
5.
If you are not, would you be willing to get involved in a Small Group?
Yes
No
6.
Are you accountable to anyone?
Yes
No, If Yes: Name: ________________________ Phone #:___________
7.
Are you currently Employed?: Yes
No
.
If Yes:
By whom? ______________________________________________
Phone # ______________
For how long? Years:
_______ Months
________
If No:
When was the last time you sought employment? _____________________________________
Are you willing to work today if we know of an available job? Yes
No
.
Provide any Reason for your answer: _____________________________________________
____________________________________________________________________________
Action taken:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
___________________________________________________
Signed: (Small Group Leader, Counselor, Deacon, Elder, Pastor):
Financial Information: (Enter largest payments for help needed)
Check Number _________ Pay To: _____________________________
Amount $
___________________
Check Number _________ Pay To: _____________________________
Amount $
___________________
Follow Up Action:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Person/People assigned follow up actions: __________________________________________________________
Date assigned Follow-up: ________________
Date Follow-Up Completed: _______________ by: ______________________________________________
Adopted by the Deacon Board:_________
Revised: _________
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