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Click here for the CHM Member Application

Click here for Brother’s Keeper Informational Letter & Application

Click here for Brother’s Keeper Direct Giving Form

CheckEase Direct Giving Enrollment Form

Instructions: Complete and submit this form if you would like to make your monthly financial gifts to CHM by automatic withdrawal from your checking or savings account. To receive this form by mail, contact us at 1-800-791-6225 and ask for the Member Assistance department.

CheckEase Change Request Form

Instructions: Complete and submit this form if you are already a participant in CheckEase Direct Giving and you would like to make a change in the date funds are withdrawn, the account from which funds are withdrawn, etc. To receive this form by mail, contact us at 1-800-791-6225 and ask for the Member Assistance department.

Request for Medical Information sheet

Instructions: Download this form if you would like to send a medical question to Dr. Michael Jacobson, CHM medical consultant. This document also contains an informational sheet about Dr. Jacobson's services. Click here to find any of Dr. Jacobson’s articles relating to your question or condition.

Member Information Update Form

Instructions: Please assist us by completing and submitting this form whenever you change your personal information (name, address, phone number, marital status, etc.) or wish to change your CHM membership status (change your participation level, add a family member to your membership, etc.). To receive this form by mail, contact us at 1-800-791-6225 and ask for the Member Assistance department.

Needs Processing packet

Instructions: Needs Processing forms must be completed and submitted when you have a medical need. This packet contains a letter from the executive director, instructions from the Needs Processing department, the Needs Processing Form (2 pages), the Authorization for Release of Medical Information Form, and the Pastor’s Form. The Pastor’s Form must be completed and signed by the member’s pastor or church official before it is submitted to CHM. To obtain a copy of this packet by mail, contact your Needs Processing representative. To find the name of the representative for your state, click here.

Prayer Page Donor Information Form

Instructions: Complete and submit this form each month if you are listed on the monthly newsletter’s Prayer Page. This form must be received by the CHM office each month by the 15th (or the first business day after the 15th) of the following month. To receive this form by mail, check the box on one of your current Donor Information Forms. For more information about the Prayer Page, e-mail prayerpage@chministries.org or call 1-800-791-6225 and ask for the Prayer Page.

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