Benevolence Assistance Request Form

Name
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Date
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Address
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City and Zip
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Date of Birth
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Home Phone
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Cell Phone
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Email
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Number of Children (Include gender and age)
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Marital Status

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Number Of Persons Living In Household
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Employment Status

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Member of GSJ

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If not, place of church membership
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Have you received assistance from GSJ in the past?

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If yes, when?
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What type of assistance did you receive?

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If other, please specifiy here
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Housing

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Amount Requested
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Utilities

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Amount Requested
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Date Requested
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Additional Comments
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Enter Code(*)
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Our Location

2396 Harry T. Moore Avenue  Map
P.O. Box 527
Mims, Florida 32754

Church Office (321) 268-8040
Pastor's Study (321) 268-1387
Fax (321) 268-3022
Church Email: gsj8040@cfl.rr.com

Service Times

Sundays:
Sunday School – 10:00 am
Morning Worship – 11:00 am

Tuesdays:
Power Tuesday
Youth – 6:00 pm
Adult Prayer Meeting – 6:30 pm
Adult Bible Study – 7:00 pm