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High Oaks, Inc.

1489 Baltimore Pike, Suite 234
Springfield, PA 19064
Phone: 610-543-1840
Fax: 610-543-1508
Email: highoaksinc@gmail.com

High Oaks supports the office of the Christian Science Nurse in accordance with Article VIII, Section 31 of The Church Manual, by Mary Baker Eddy. High Oaks accepts applications for benevolence from individuals who are relying on Christian Science for healing and need assistance on a temporary basis with payments for Christian Science nursing care in a facility or at home and with Christian Science practitioner fees. High Oaks considers requests for emergency funds for other than nursing or practitioner needs on a short-term basis. Assistance is also given for Christian Science Nurses training courses and tuition for Christian Science Camps. All benevolence is offered in support and expectation of healing.

APPLICATION FOR BENEVOLENCE – Please answer all questions completely and return by the 15th of the month for consideration. All information will be kept strictly confidential. (If you need assistance in completing application, please contact High Oaks.)

First Name

Last Name

Email

Telephone

Address

City

State

Zip

1. Please state your reasons for needing benevolence? (Explain your current financial situation and need.)

2. What specific bill(s) do you need assistance with? (Please send a copy of your bill(s) in order for your application to be considered.)

3. What amount are you able to pay on the bill(s)?

4. What amount are you requesting High Oaks to pay on the bill(s)? (Please note that approved benevolence is paid directly to the service provider.)

5. Please explain your current financial situation (include your spouse, if applicable).

Current Checking Account

Current Savings Account

Total Monthly Income

Employment

Pension

Social Security

Interest

Dividends

Other (Please List)

Total Monthly Expenses

Mortgage or Rent

Loans

Credit cards

Food

Phone

Other (Please List)

6. What additional sources of financial assistance do you have to help pay the bill(s), including but not limited to: health insurance; retirement account; family; public assistance; church; association; other?

If so, what amount?

7. Have you applied for benevolence at other Christian Science sources?

Yes

No

Where did you apply?

When did you apply?

For what amount?

8. Are you relying on Christian Science for healing and receiving treatment on a regular basis from a practitioner listed in The Christian Science Journal?

Yes

No

If not, please explain.

9. Are you a member of The Mother Church?

Yes

No

and of a branch church or society?

Yes

No

10. Do you attend Christian Science services on a regular basis?

Yes

No

If not, do you listen to church services via telephone or internet?

Yes

No

Who has this application been completed for?

Myself

Someone Else

Date

Signature

Individual completing application (if other than applicant):

First Name

Last Name

Relationship

Telephone

Date

Signature

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