Date: ____________________

Organization or Person Requesting Funds: ____________________________________________

Contact (name, phone, email):______________________________________________________

Address: ______________________________________________________________________

Project: _______________________________________________________________________

Please provide the following information, add additional sheets if necessary:

If matching funds following a fundraiser -

Event cost information, please itemize.

Donations, funds raised, income source information.

Amount of funds being requested.

If matching funds to donations -

Date, initials of donor and amount of each donation.

Amount of funds being requested.

Additional information if any: ______________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Place completed form with requested documentation, in the Foundation box in the Church office.
Or email information to the Foundation.

Thank you.

________________________________________
Signature

Revised August 2016