Have A Need?

Fill out this form with AS MUCH DETAIL AS POSSIBLE so that we can try to help out as much as possible.

You will hear from someone within 5 business days of submitting this form.

Your name *

Email address *

Phone Number *

Address *

Please submit a photo of your driver's license or other form of I.D. *

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Add up to 5 files. Maximum file size 10 MB.

Marital Status *

List everyone currently living in your home beside yourself (please include name, age, and relationship). *

Employment Information (include name of employer and dates of employment for current and previous employer). *

Tell us about your need *

What brought you to LIFEGATE? Are you a covenanted member? *

Some details for you to know...

This resource is designed to help those in need of short-term financial assistance. Through prayer and discernment, the Leadership team will find the best way to help with each individual need. No money will be given directly to the individual, but instead, will be made payable to the provider of the service.

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