Relief Fund Application

Relief Fund Purpose Statement

This relief fund is resourced by the love and generosity of our Christian family. The fund provides assistance for those directly affected by the COVID-19 pandemic by providing grocery cards to those who qualify. The goal is to help as many people in need as possible beginning with those in the greatest need. Many factors affect our ability to grant assistance and all may not qualify. Subject to funds availability. (This form has been updated, please read carefully)
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
Email
example@example.com
Are you a member of The Rock? (verifiable by our church records which means you filled out a Welcome card or gave an offering at least once) *

Yes No
If so, which congregation?

Anaheim English Corona English Hesperia Lake Elsinore Seal Beach English West Anaheim English West Anaheim Spanish Battle Creek, MI Kalamazoo, MI
How many adults (18 years old and older) currently live in your home? *
How many children (0-17 years old) currently live in your home? *
Are you or an adult in your household employed? *

Yes No
Has this adult's hours been reduced due to the Coronavirus restrictions? *

Yes No
Have you researched local/county/state assistance? (Many programs are available during this crisis.) *

Yes No
This relief fund is to help provide grocery cards affected by the Coronavirus situation. Tell us your story. Be as specific as you can. *
Should be Empty:

Relief Fund Purpose Statement