CityCare Financial Assistance - New Life Church

Financial Assistance – New Life CityCare Counseling

Financial assistance is not a discount on services, but is funding made possible by the generous donations of New Life Church Kingdom Builders.

Name (First and Last)(Required)

Mailing Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Phone(Required)

Email(Required)

Date of Birth(Required)

Name of your New Life CityCare Counselor(Required)

First and last names and dates of birth of all persons living in this household.(Required)

Do you have health insurance?(Required)

Use this space to include additional information or extenuating circumstances.(Required)

Total annual household income (before taxes).(Required)

I am currently receiving

SSI

Child Support

Unemployment

Alimony

Disability

Rental Assistance

SNAP

Financial Documentation

Max. file size: 300 MB.

Please provide at least one of the following: RECENTLY FILED FEDERAL TAXES (Federal Tax Forms(s) for all income in the household), FOUR RECENT PAYSTUBS per working adult in the household, or GOVERNMENT ASSISTANCE showing most recent 30 days of income

New Life CityCare Financial Assistance

Financial Assistance – New Life CityCare Counseling