How Can We Help?

Please fill out the questionnaire below to request a grant on behalf of an individual. Should you have any questions about the form or your request, please reach out to Nina Faragher, the Society administrator of the Boston Episcopal Charitable Society at boston.episcopal.1724@gmail.com. Thank you!

To be completed by priest requesting support on behalf of a parishioner or congregant.*

In order to streamline the grant request process and help our committee make a determination on your request, please provide the following information on the parishioner or congregant for whom you are requesting support.

*Please do not include any confidential health information on this form, particularly sensitive information to alcohol or drug abuse, mental health or confidential HIV/AIDs-related information. If the parishioner or congregant requests that you include certain health information on this form because it is relevant to this grant request, please limit the information to only that necessary and inform them that this information will be used and disclosed to/by the committee and others to make decisions about this grant request.

Name of Parishioner or Congregant

First Name

Last Name

1. How did you learn about the Society?

2. What are the parishioner's or congregant's circumstances that prompted your request to the Society?

3. How will this grant be used (for example, mortgage, utility bills, food and clothing needs, medical supplies, etc.)?

4. What is the parishioner's or congregant's relationship with the church, including their history and current involvement?

5. What is the structure of the household involved (for example, single person, couple, family with children, single parent, etc.)?

6. Please provide current employment information for the parishioner or congregant and their household members.

7. What is the current monthly rent or mortgage?

8. Please provide an estimate of current monthly expenses in addition to rent or mortgage. What is the current monthly rent or mortgage?

9. Please provide an estimate of current monthly income (including any child or spousal support).

10. Are there other avenues of support (for example, savings accounts, CDS, help from family members, etc.)?

11. Amount of Request

12. A concern of the committee is how your parishioner or congregant and their family will be able to manage going forward. Please let us know.

13. Please provide any additional information you feel will help the committee make an informed decision about your request.

Submitted By

First Name

Last Name

Name of Parish or Congregation

Parish or Congregation Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How Can We Help?

The Boston Episcopal Charitable Society