HIGH OAKS, INC

726 Fitzwatertown Rd.  #7   Willow Grove,  PA  19090    Tel: 215-706-4300/ Fax: 215- 706-0198

             APPLICATION  FOR  BENEVOLENCE -  PLEASE ANSWER ALL QUESTIONS

     (Please return by the 15^th of the month for consideration at the current monthly meeting)

             For prompt consideration, you are responsible to completely enter the information requested.

                                      All information you provide will be kept strictly confidential

 

 Name:___________________________________________   Tel: (     )___________________

 

Address:_______________________________________________________

 

City______________________________________  State:________________ Zip:__________

1.  Reason for requesting benevolence?  (Explain your current financial situation and need.)

 

 

 

 

 

.  Are you relying on God for healing through the application of Christian Science, and receiving treatment from a Christian Science practitioner?*

3.  Are you a member of a Christian Science branch church or Society? _______

     If not, are you able to attend Christian Science services regularly? ______

 

4.  What other sources of financial assistance do you have to help pay these bills, including but not limited to, health insurance, family members, church or association?

 

 

5.  Have you made application to other Christian Science benevolence sources?  _____ .                                         If yes, where?  _______

 

6. What amount are you able to pay on this bill?$_______.       Amount requested?   $_________.                                (Please enclose copies of appropriate bill.  Bills are paid directly to where the money is owed.)            

   

Signature of Applicant________________________________________  Date_____________

             * High Oaks, Inc. is devoted to providing benevolence for individuals who are relying on God through the application of Christian Science for healing.  Benevolence is based on need while one works out their demonstration in Christian Science.  High Oaks                  supports the office of the Christian Science nurse in accordance with the Manual of  the Mother Church.

                                       Other sources of benevolence for Christian Scientists. 

THE DOMINION FOUNDATION   Richmond, VA                        804-257-9062        

                          Financially assists with home nursing care costs.

THE PRINCIPLE  FOUNDATION  Kansas City,  MO                   800-826-7756

                          Provides general financial help for those in need.