Metro Cares Fellowship Fund - Metropolitan Baptist Church

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Metro Cares Fellowship Fund Mariana Garcia August 25, 2023 August 25, 2023

- Step 1 of 3

MBC Financial Assistance Form

Information Request Form

Date Submitted *

Full Name *

First

Last

Street Address *

Address Line 1

City

State

Zip Code

Mobile/Cell Number *

Email *

How did you hear about Metropolitan Baptist Church? Please select all that applies. *

I am a member of Metropolitan Baptist Church
Relative
Friend
Radio
Internet
Other

Reason for Need - Please briefly explain the circumstances that brought this need. *

Description of need - Please check all that apply *

Food
Medicine
Clothing
Shelter
Rent/Mortgage (Payable to Landlord/Mortgage Company)
Utilities (Payable to Utilities Company)
Other

If financial assistance is requested, are you willing to receive financial counseling *

Yes
No

Have you previously been helped by Metropolitan Baptist Church *

Yes
No

Date help was received

List other Churches or Agencies you have applied to for assistance: *

Additional Information Needed

Please provide information requested below as related to the boxes checked in the description of need section above.

Landlord's Information/Name *

Landlord's Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Company Name *

Company Phone *

Contact Person Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Account Number *

Payment Due Date *

Total Amount Due $ *

Amount Required $ *

Requester's Name *

First

Last

Signature *

Date *

Metropolitan Baptist Church - Administration Use Only

Received By Whom

First

Last

Date Received

Fellowship Fund

Approved
Disapproved

Comments

Check Payable To:

Amount $

Check Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Disbursement Date

Disbursement Officer

Metropolitan Baptist Church

(202) 238-5000
1200 Mercantile Lane
Suite 115 B
Largo, MD 20774

Hours of operation:

M-F 10AM-4PM ET
Sat (9AM-2PM) ET
Sunday Worship 10AM ET

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