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Mercy Request
Please complete this form to the best of your ability.
A member of our Mercy Team will get in touch with you within 24 hours.
First Name
Last Name
Email
Phone Number
Gender
Male
Female
I'd rather not say
Marital Status
Single
Married
Widowed
Separated
Divorced
I'd rather not say
Spouse's Name
How are you connected to New City?
Member
Regular Attender
Visitor
Have not visited yet
Have you been previously assisted by the church?
Yes
No
What was the help for specifically? Please include dates and description of assistance.
What is the current problem you are having?
How long has the problem been going on?
What things have you done (or left undone) that have contributed to this situation?
What needs to change to prevent this from happening again?
What steps have you already taken to remedy the situation?
What is your specific request of the church? Please include a dollar amount if asking for financial assistance.
Are you willing to work with the church to create an action plan aimed at solving your current problems as well as working to help prevent this problem from occurring again?
Yes
No
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