Jesus' Helping Hand Relief Fund

*This form is for Dallas 1 Corporation employees only.
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Supervisor/Foreman Signature: *
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Personal Monthly Budget
Monthly Income *
 Projected Monthly Income
Income 1
Extra income
Housing *
 Projected Cost
Mortgage or rent
Phone
Electricity
Gas
Water and sewer
Cable
Waste removal
Maintenance or repairs
Supplies
Other
Transportation *
 Projected Cost
Vehicle payment
Bus/taxi fare
Insurance
Licensing
Fuel
Maintenance
Other
Insurance *
 Projected Cost
Home
Health
Life
Other
Food *
 Projected Cost
Groceries
Dining out
Other
Pets *
 Projected Cost
Food
Medical
Grooming
Toys
Other
Personal Care *
 Projected Cost
Medical
Hair/nails
Clothing
Dry cleaning
Health club
Organization dues or fees
Other
Entertainment *
 Projected Cost
Video/DVD
CDs
Movies
Concerts
Sporting events
Live theater
Other
Loans *
 Projected Cost
Personal
Student
Credit cards
Other
Taxes *
 Projected Cost
Federal
State
Local
Other
Savings or Investments *
 Projected Cost
Retirement account
Investment account
Other
Gifts and Donations *
 Projected Cost
Charity 1
Charity 2
Charity 3
Other
Legal *
 Projected Cost
Attorney
Alimony
Payments on lien or judgment
Other
Relief Fund Guidelines:
 
- Documentation showing why you need relief funds will be required.
 
- The Jesus' Helping Hand Relief account must have funds available in order for any requests to be approved. In addition, no Jesus' Helping Hand request can exceed the current amount of funds that are currently available in the account.
 
- No more than 2 requests per 12 months can be made by any individual. If 2 requests are made, within a 12 month period, that individual will be required to obtain (and show proof) of financial counseling. HR can provide assistance for these resources.
 
 
Reminder: Weekly contributions to the plan are not required to request funds but if you are requesting funds it would be greatly appreciated that you start contributing to this plan.