Beth Welfare Form
Please let us know about any issues or concerns you're facing.
Personal Information
Your Name
*
Your Phone Number
*
Your Class
*
-- Select your class --
TAM
Lithos
Solitaire
Petros
Archpetros
The Auxan You Belong To
*
Your Auxan Leader's Name
*
Year You Joined the Ministry
*
-- Select year --
Your Residence
*
Your Occupation
*
Guardian Information
Guardian's Name
*
Guardian's Occupation
*
Your Current Need
Tell us the details of your current situation/need
*
Add media for context
How urgent is your need?
*
-- Select urgency --
Very pressing need
Somewhat urgent
Can wait but important
I confirm that the above information is true and honest
*
Submit