CHRISTMAS

BENEVOLENCE FUND

APPLICATION

Fill in this form to apply to receive a grocery gift card to help with the financial costs of Christmas, or to nominate another individual/family to receive one.

Please note that filling in this form does not guarantee you will be given a grocery gift card or that you will be allocated the amount you requested. Allocations will be made at the discretion of the Antioch Leadership Team based on funds and the needs of all applicants.