Financial Assistance Request

He comforts us in all our affliction, so that we may be able to comfort those who are in any kind of affliction, through the comfort we ourselves receive from God. (2 Corinthians 1:4)

Many individuals and families in Hawaiʻi are suffering during this time, and we want to bring practical help and comfort. Our resources are limited, but we will assist where we can.

COVID-19 Financial Assistance Request

Personal Information

First Name *

Last Name *

Phone *

Email *

Street Address *

City *

State *

ZIP *

Do you regularly attend Harbor Church? *

Yes

If no, how did you hear about Harbor?

Reference

Please provide one person as a reference (i.e. community group leader, boss, friend)

Name *

Phone or email *

Household Members

Please enter information for all household members, including yourself. Please only account for dependents in your household.

How many immediate family members do you have in your household? (include yourself, spouse, and children) *

How many people in your household are of working age (including yourself)? *

General Financial Information

Please include yourself and ALL household dependents

Does anyone in your household expect to receive financial assistance this month or next month? (i.e. CARES Act, nonprofit grants, etc.) *

Yes

If so, what is the expected amount?

Provide the amount you have in your personal checkings, business, and/or saving accounts *

Provide the amount of cash you "have on hand" *

Provide the amount of unearned income you are receiving (i.e. social security, SSI, retirement, pension, unemployment benefits, settlements, child support, etc.) *

Provide the amount you have in your stocks/bonds (savings bonds) accounts *

Provide the amount you have in your money market/time certificate accounts *

Provide the amount you have in your IRA/KEOGH/Deferred compensation accounts *

Financial Situation

What is the approximate total of your monthly expenses (mortgage, rent, food, transportation, etc.)? *

Do you have a personal/family monthly budget you follow? *

Yes

Are you or anyone in your household currently employed? *

Yes

Who are the employers?

How much do you and your household earn per month (gross income before taxes)? *

If you are unemployed, have you filed an unemployment claim?

Yes

Financial Need Information

Provide the financial amount you want to request *

In the space below, please describe the specific bills you will utilize your requested funds to pay for. *

Conditions Upon Acceptance

If you are approved, we will ask you to submit the following:
a. Copy of each bill statement you will use the requested funds for
b. Copy of living expenses you will use the request funds for that do not have a bill statement available

Signature

I affirm that the information in this form is true and accurate according to my knowledge.

Type name as signature: *

Date *

Join Us

Sunday Mornings
8am | 9:30am | 11am

Location:
590 Farrington Highway
Kapolei, HI 96707

Contact Us

[email protected]
(808) 556-2969

Mailing Address:
590 Farrington Highway Unit #524-450
Kapolei, HI 96707