Financial Assistance Application

Please complete the Financial Assistance Application. Take your time and answer completely and honestly.

Application Purpose

Free People Church seeks to be a source of support to those in our community that are in need, particularly those who are actively engaged in the Free People Family. These guidelines are not meant to discourage you, but to allow us to be better equipped to evaluate your current situation and determine how to best help.

Your name *

Last name

Email address *

Address *

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Phone Number *

Phone type

Birthdate *

Household members

Application Process and Limitations

Limitations of Usage: You may apply for financial assistance from Free People Church not more than once every six months. If you have not regularly engaged in serving, giving or Groups at Free People for at least six months, your assistance limit is one $50 Kroger gift card.

Interview: Applicants may be interviewed before a final decision is made. We reserve the right to ask for documentation to verify eligibility for assistance. In-person interviews can only be scheduled following the last service on a given Sunday.

Processing: This application is to be completed prior to the interview process. Please allow one week for review of your application. You may be contacted via phone, e-mail or letter.

Payments: Payments will be made to third parties only.

Documentation: All applicants are required to complete the Financial Assistance Application in its entirety.

Applicants are also required to provide supporting documents where needed (i.e., valid ID, invoices, bills, etc.).

Availability of Funds: Free People Church may provide assistance with the following: rent, utilities, food, clothing or other emergency needs, depending on available funds and the nature of the need requested.

Exclusions: Free People Church will not pay for non-emergency items, which include, but are not limited to cell phone bills, cable/satellite TV bills, insurance payments, credit card bills, etc.

Application Process and Limitations *

I have reviewed and understand the limitations and process.

Requirements

Anyone who engages in serving, giving or Groups at Free People is eligible to apply for financial assistance as needed. Any other community member within 20 miles of the church location is eligible to complete the application process with the restrictions outlined below.

Have you applied for financial assistance at Free People within the last six months? *

Do you currently attend Free People Church? *

Do you live within 20 miles of Free People Church? *

Consent to Restrictions *

I understand that because I am not a part of the Free People Family, my ability to receive financial assistance is limited to $50 and there is no guarantee of financial support from Free People Church, and I agree to these restrictions.

MINISTRY NEED

What is the main reason you’re seeking ministry or the main thing you’re wanting help with? *

Please BRIEFLY explain

Please describe any “symptoms” associated with this issue, including any physical health problems, mental/emotional issues, relational issues, or demonic oppression/manifestations. *

MENTAL & EMOTIONAL HEALTH

When did this difficulty (or these symptoms) start in your life and was there anything negative that happened to you at that time (personally, relationally, etc.)? *

Please Briefly Explain

Have you ever attempted suicide or been admitted for psychiatric care? *

Have you had any close family or friends commit suicide? *

Do you currently hold anger, bitterness, hatred or resentment against anyone (living or dead) that you know of? *

Do you struggle with the following negative EMOTIONS: *

Depression/Major Discourgement

Suicidal thoughts

Self-harm

Lust (pornography, masturbation)

Fornication

Anger and Rage

Loneliness

Physical pain

Feel like you're going insane

Nightmares

Demonic sexual dreams

Fear

Shame

Self-Criticism

Rejection from others

Other

SPIRITUAL HISTORY & INVOLVEMENT

Have you ever been involved in any of the following groups/organizations, or practices (even if just one time, even if it was years ago)?

OCCULT:

Witchcraft

Wicca

New Age

Transcendental Meditation

Astrak Projection

Hypnosis

Mind Control

Table Tilting

Speaking Trance

Telepathy

Clairvoyance

Fortune Telling

Going to Psychics

Tarot Cards

Palm Reading

Ouija Board

Blood Pacts

Astrology

Seances

Demonic Dreams

Literally Seeing, Hearing from, or Consulting the Dead

Talking to a Deceased Loved One on a Regular Basis

Games like Dungeons & Dragons

Abortion

Other

CULTS:

Christian Science

Unity / Unitarianism / Unification Church

Scientology

Jehovah’s Witnesses

Children of God

Mormonism / LDS

The Way International

Freemasonry / Eastern Star

New Age

Yoga (spiritual or meditative that was NOT Christian-based)

Theosophy

Other

RELIGIONS:

Zen Buddhism

Hare Krishna

Bahai’ism

Rosicrucianism

Science of Mind

Silva Mind Control

Eckankar

Erhard Seminars

Transcendental Meditation

Islam

Black Muslim

Hinduism

Dowsing (rod or pendulum)

Magic (black or white)

Other (anything else NOT Christian but spiritual in nature)

Do you have any hereditary spirits passed down from your parents or family tree? *

Have you experienced rejection during pregnancy, father/mother wounds, or rejection from others? *

Have you experienced any victimization or trauma? Like rape, molestation, sexual abuse, or witnessing a murder? *

DELIVERANCE HISTORY

Have you ever been through a personal Deliverance Prayer Session (or inner healing) for yourself? *

Are you currently taking any medications for any anxiety, depression, or mental health conditions? *

READY FOR DELIVERANCE

Do you desire to be delivered? *

Are you willing to stop conscious sin, break bad habits, and cut off ungodly relationships? *

Do you promise to stay close to Jesus? *

CONSENT AND AGREEMENT FOR SERVICES

I agree to the terms outlined. *

I acknowledge that the Spiritual Health Team members from Free People Church have voluntarily agreed to meet and pray for me. *

I understand that this session is not a professional counseling meeting or relationship and that none of the team members are acting as licensed counselors. *

I understand that these team members are, to the best of their ability, doing what they can to help me achieve more freedom in my life. *

I understand Free People Church is a nonprofit Ohio Corporation offering services free of charge. I have voluntarily sought help and am under no obligation to accept or reject any counsel or support provided by the team members of this ministry. *

I understand that in some instances physical and emotional reactions can result in response to this ministry time. *

I understand that the Spiritual Health Team is committed to respect my disclosed information. The information, as needed, may be shared with appropriate leaders at Free People Church, so as to further the total healing process. *

I agree to hold Free People Church and its team members free from any and all liability, loss or damage of any kind that may arise as a result of assistance which I have received or from my involvement with the Spiritual Health Team. *

I have read this disclaimer/release of liability and understand its terms and agreements. My electronic signature signifies my agreement with it and that I am executing it as my free and voluntary act. *

Media Release *

By registering to Digital Deliverance you are agreeing to being filmed, recorded, or photographed.

You also agree and release to use this media content however it seems fit to glorify the name of Jesus.

Electronic Signature *

By entering your name in this box, you are electronically signing this form and affirming that your consent and agreement are given freely, fully, and truthfully.

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Free People Church
hello@freepeople.church
937-265-8610