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June 29, 2020 5:32 pm Published by vibrantadmin

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Palisades Park High School

1 Veterans Plaza, Palisades Park, NJ

1 Veterans Plaza
Palisades Park, NJ 07650

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1 Veterans Plaza
Palisades Park, NJ 07650

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Justice and Mercy

Application For Financial Assistance
The Justice and Mercy Ministry (“JM”) within New Mercy Community Church seeks to aid those experiencing financial hardship by providing need-based grants. All of the information you provide will be kept STRICTLY CONFIDENTIAL aside from the JM ministry. To allow JM to make an informed decision about your needs, please fill out the application form below and submit. We will reach out to you shortly after submitting. You can also email us at justice@newmercy.cc * Required
Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Is this your first time applying?*
- Yes
- No
If No, please give details on any prior applications:
How did you hear about us?*
Requested financial amount ($):
Please provide the date by which you need the requested financial amount and the reason for such deadline:*
Please provide the reason for your request for financial assistance. Please be as specific as you can comfortably share.*
Employer Name*
Supervisor Name*
Company Address*
Company Zip Code*
How long have you been employed at your current job?*
If less than a year, what was your prior job and length of time?*
Weekly Salary Amount (please divide your salary accordingly).*
Please describe any other sources of income (specify $ amounts)*
Your monthly obligations for Rent/Mortgage?*
Car payments?*
Credit Card Payments?*
Student Loan Payments?*
Cell Phone Bills*
Any other financial obligations?
What is currently your Bank Balance (combined)?*
What is your retirement account balance?*
Any other assets?*
Agreement and Submission

By submitting this application for financial assistance, I affirm that all of the facts and statements set forth in it are true and complete. I understand that any false statements, omissions, or other misrepresentations made by me on or in connection with this application will result in disqualification for financial assistance. We thank you for completing this application. A JM team member will contact you as soon as we have completed our review. We may also request clarifications or additional documentation to assist our review. This application and any other information you share with JM will be used solely for the purpose of assessing our ability to assist you. JM will not share your information publicly.