Potential Recipient Contact Form

Name *

First

Last

Email *

Do you have a significant amount of personal debt (credit cards or personal loans) with interest rates in excess of 10% that is making it difficult for you to meet regular bill payments and other necessities? *

• Yes
• No

Are you prepared to provide documentation of your financial need including income documentation? *

• Yes
• No

Do you attend Mass at least weekly and assent to the moral teaching of the Church? *

• Yes
• No

Can you provide the Institute, upon our request, with a letter from your parish priest attesting to your weekly attendance and assent to the moral teaching of the Church? *

• Yes
• No

Are you prepared to commit to the Institute's financial educational program in preparation for debt relief? *

• Yes
• No

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