VCC Financial Assistance Application

Our goal is to show Christian compassion, and to provide help that has a long-term benefit to you so that you are not facing financial difficulties in the future. Please fill out completely and include the requested attachments.

First Name

Last Name

Birth Date

Street Address

City

State

Zip

Own Rent Other

Email

SSN or CA DL

Phone:

Employer

Since

Job Title

Street Address

City

State

Zip

Spouse/Family:

First Name

Last Name

Birth date

Street Address

City

State

Zip

Own Rent Other

Email

SSN or Ca DL

Phone:

Employer

Since

Job Title

Address

City

State

Zip

Children living with you:

Child 1:

Age

Child 2:

Age

Child 3:

Age

Child 4:

Age

Referred by

Phone

Request: We do not make direct payments to you. For your request, attach a copy of the bill or rental/lease agreement. It must be a current bill or rental/lease agreement in your name.