KBF Referral - Kairos Benevolence Fund

REFERRAL

Individuals wishing to refer someone to the Kairos Benevolence Fund (KBF) for assistance should complete all of the following information. You must be willing to be contacted by KBF for additional clarification or details; however, you may request that you remain anonymous to the person you refer. Your referral will be contacted and asked to complete an application form. Every attempt will be made to maintain confidentiality throughout this process if you so desire.

Once you have completed the information requested, you may click submit to send the information electronically, or you may print and mail the form to:

Kairos Benevolence Fund
PO Box 19142
Tucson, AZ 85731-9142

YOUR CONTACT INFORMATION

Your First Name:

Your Last Name:

Your Phone Number (numbers only):

Your Email Address:

Your Mailing Address:

NAME OF INDIVIDUAL OR COUPLE YOU ARE REFERRING TO KBF

Their First Name:

Their Last Name:

Their Phone Number (numbers only):

Their Email Address:

Their Mailing Address:

What is your relationship or connection with this individual or couple?

What ministry(s) has this individual or couple been involved with?

What type of health or financial situation is this individual or couple facing?

When KBF contacts this individual or couple, may we tell them that you referred them to us, or do you wish to remain anonymous?

You have permission to give them my name I prefer to remain anonymous

Any other information you want to share with us?

Today's Date: