Cypress Financial Assistance Application

Cypress Church provides various forms of assistance to those who may be in need. If you are requesting financial assistance, you must fully complete this application. A committee will review your confidential application, and a representative will contact you discretely. This process may take up to five (business) days for completion. As always, we are willing to come alongside in the form of prayer, listening, and being a conduit for Christ to those in need.

Financial need requests will only be considered if you are a member or active attendee of Cypress Church. If you are not a member or do not participate in the life and ministries of Cypress Church, we have created a comprehensive brochure providing information on other alternative funding and counseling services.

Work Entry

Added: 4/30/2025

PERSONAL INFORMATION

First Name

Last Name

Spouse First Name

Spouse Last Name

Address

Phone (Home)

Phone (Cell)

Total # of Adults per Household

Total # of Dependents per Household

Dependents' names and ages

Occupation

Employer's Name

Gross Annual Income

Spouse's Occupation

Spouse's Employer

Spouse's Gross Annual Income

Other amounts and sources of income (including government subsidies, annual alimony, and/or child support if any)

Total Annual Family Income

MONTHLY EXPENSES

Home Mortgage Payment/Rent (include property taxes)

Utilities (Electric/Gas/Water/Telephone)

Food/Gas/Medicine

Motor Vehicle Payment

Insurance (Medical/Life/Homeowner/Auto)

Alimony/Child Support Expenses (if any)

Other Miscellaneous Monthly Expenses

Charitable Giving (including to Cypress Church)

Total Monthly Expenses

SUPPLEMENTAL QUESTIONS

Who referred you to the Financial Assistance Team?

Do you attend Cypress on a regular basis?

No Yes

Home Campus

How long have you been attending Cypress Church?

Do you regularly give to Cypress Church? Or Do you regularly support Cypress Church through your financial giving?

No Yes

Are you in a small group?

No Yes

What type and amount of assistance are you seeking?

How long will this solve the problem?

Do you expect to need financial support in the future?

Have you approached any other organization for help in the past 12 months?

No Yes

Please provide a summary of your situation. Please understand that the interview process often involves probing, detailed, difficult, and potentially uncomfortable questions which may be necessary to determine a workable situation.

Summary

CONFIDENTIAL

Completing this application helps our team work with you to determine the best course of action for your situation. Certain information may be verified with our database.

This application will be reviewed by a designated team of staff members in a confidential process to determine if aid will be given. I understand that this form will be reviewed by a confidential team of staff members to determine if aid will be given.

I certify that the information I provided is true and accurate.

Electronic Signature of Person Filling out Form

Signing Date

Electronic Signature of Spouse (if applicable)

Spouse Signing Date

Submit