Financial Assistance Grant Request

Our denomination has been blessed with matching grant funds to offer $2000 Financial Assistance grants to the 25 senior pastors that have a special financial need (see question 1) and meet the criteria (see question 2).

1. Check any of the following special needs you have at this time:

Space Cell	Yes	No
Unpaid medical bills greater than $5,000	Unpaid medical bills greater than $5,000: Yes	Unpaid medical bills greater than $5,000: No
Student loans greater than $20,000	Student loans greater than $20,000: Yes	Student loans greater than $20,000: No
I am over 45 years old and do not have a personal retirement account, and my church leaders are open to budgeting $1000 for a denominational retirement account in 2019.	I am over 45 years old and do not have a personal retirement account, and my church leaders are open to budgeting $1000 for a denominational retirement account in 2019.: Yes	I am over 45 years old and do not have a personal retirement account, and my church leaders are open to budgeting $1000 for a denominational retirement account in 2019.: No

2. Check all of the following grant criteria that applies to you

Space Cell	Yes	No
Senior pastor that is ordained, credentialed or licensed in our denomination	Senior pastor that is ordained, credentialed or licensed in our denomination: Yes	Senior pastor that is ordained, credentialed or licensed in our denomination: No
Visited the www.NAEfinancialhealth.org/sample website and previewed (with my spouse, if married) the Personal Finance online course	Visited the www.NAEfinancialhealth.org/sample website and previewed (with my spouse, if married) the Personal Finance online course: Yes	Visited the www.NAEfinancialhealth.org/sample website and previewed (with my spouse, if married) the Personal Finance online course: No
Visited the http://www.NAEfinancialhealth.org/sample and previewed the Church Generosity six monthly committee-based lessons	Visited the http://www.NAEfinancialhealth.org/sample and previewed the Church Generosity six monthly committee-based lessons: Yes	Visited the http://www.NAEfinancialhealth.org/sample and previewed the Church Generosity six monthly committee-based lessons: No
Chosen and talked with a designated lay leader that has reviewed this application, previewed the online Church Generosity lessons and has agreed to schedule these committee-based interactive lessons for the pastor and 3+ lay leaders starting in January	Chosen and talked with a designated lay leader that has reviewed this application, previewed the online Church Generosity lessons and has agreed to schedule these committee-based interactive lessons for the pastor and 3+ lay leaders starting in January: Yes	Chosen and talked with a designated lay leader that has reviewed this application, previewed the online Church Generosity lessons and has agreed to schedule these committee-based interactive lessons for the pastor and 3+ lay leaders starting in January: No
If I am approved for a Financial Assistance grant in August, I agree to start the Personal Finances course in September (with my spouse, if married) and the Church Generosity course with at least 3+ lay leaders in January.	If I am approved for a Financial Assistance grant in August, I agree to start the Personal Finances course in September (with my spouse, if married) and the Church Generosity course with at least 3+ lay leaders in January. : Yes	If I am approved for a Financial Assistance grant in August, I agree to start the Personal Finances course in September (with my spouse, if married) and the Church Generosity course with at least 3+ lay leaders in January. : No
I understand both courses must be completed between September 1, 2018 and August 31, 2019. This includes having my lay leaders help schedule the use of a churchwide generosity devotional and Bless Your Pastor brochure and offering before by the end of December 2019.	I understand both courses must be completed between September 1, 2018 and August 31, 2019. This includes having my lay leaders help schedule the use of a churchwide generosity devotional and Bless Your Pastor brochure and offering before by the end of December 2019.: Yes	I understand both courses must be completed between September 1, 2018 and August 31, 2019. This includes having my lay leaders help schedule the use of a churchwide generosity devotional and Bless Your Pastor brochure and offering before by the end of December 2019.: No

3. How did you first hear about the Financial Health courses and grant?

4. Please provide the following contact information. All information is required. If not married, in the spouse boxes put the word: no

Space Cell	First Name	Last Name	Area Code/Cell	Email
Pastor	Pastor: First Name	Pastor: Last Name	Pastor: Area Code/Cell	Pastor: Email
Spouse	Spouse: First Name	Spouse: Last Name	Spouse: Area Code/Cell	Spouse: Email
Lay Leader	Lay Leader: First Name	Lay Leader: Last Name	Lay Leader: Area Code/Cell	Lay Leader: Email

5. Please provide the following church information.

Space Cell	Church Name	Worship Attendance	Annual Budget	Phone w/Area Code
-	-: Church Name	-: Worship Attendance	-: Annual Budget	-: Phone w/Area Code

6. Please provide the following personal information

Space Cell	Your Age	Medical Debt $	Student Loan Balance	Annual Church Salary/Housing
-	-: Your Age	-: Medical Debt $	-: Student Loan Balance	-: Annual Church Salary/Housing

7. Please provide the following mailing information

Space Cell	Name	Address	City, State	Zip
Church	Church: Name	Church: Address	Church: City, State	Church: Zip
Home	Home: Name	Home: Address	Home: City, State	Home: Zip