My signature below guarantees the information provided above is accurate and true. I also understand that benevolence from this church is a one-time gift and I cannot re-apply for another request for a period of one (1) year. I give Appalachian Church permission to verify any information given on this request for assistance, unless I have noted otherwise, in writing, on this form. Verification of information may include correspondence, phone calls or visits.
Please email us current copies of bills for consideration.