Financial Assistance Request

He comforts us in all our affliction, so that we may be able to comfort those who are in any kind of affliction, through the comfort we ourselves receive from God. (2 Corinthians 1:4)

Many individuals and families in Hawaiʻi are suffering during this time, and we want to bring practical help and comfort. Our resources are limited, but we will assist where we can.

Before making a financial request, please carefully look through the Covid Resources Page and apply at the listed organizations for any assistance you are eligible for.

COVID-19 Financial Assistance Request

Personal Information

Do you regularly attend Harbor Church? *


Please provide one person as a reference (i.e. community group leader, boss, friend)

Household Members

Please enter information for all household members, including yourself. Please only account for dependents in your household.

General Financial Information

Please include yourself and ALL household dependents

Have you carefully checked the Covid Resource Page at the link on the top of this page? *
Does anyone in your household expect to receive financial assistance this month or next month? (i.e. CARES Act, nonprofit grants, etc.) *

Financial Situation

Do you have a personal/family monthly budget you follow? *
Are you or anyone in your household currently employed? *
If you are unemployed, have you filed an unemployment claim?

Financial Need Information

Conditions Upon Acceptance

If you are approved, we will ask you to submit the following:
a. Copy of each bill statement you will use the requested funds for
b. Copy of living expenses you will use the request funds for that do not have a bill statement available


I affirm that the information in this form is true and accurate according to my knowledge.