Outreach Team:  Funding Request Form

Note: Bethel Lutheran Church’s Outreach Team only meets once a month, so please note that requests might take more than 30 days to be reviewed. Please return completed form to the office or Marie St. Gelais.


Date of Request: _________________________________________________             

Organization: ___________________________________________________________________________________________  Phone Number: ___________________________________     

Address: _______________________________________________________________________________________________  Nonprofit Tax ID Number: __________________________

Contact: _______________________________________________________________________________________________  Title: _______________________________________________  

Phone Number: _______________________  Email Address:  _____________________________________________________________________________________________________

 

Please provide the following Funding Request Information:

  1. What type of fund request are you applying for? (please check all that would apply)

____ one-time funding need                           ____ monthly funding need        ____ annual funding need

  1. What is the primary purpose of the funds needed? (Please check all that apply)

____ Emergency Assistance                          ____ Medical Help                        ____ Education                           ____ Church Planting                     ____ Leadership Development

____ Evangelism/Christian Outreach           ____ Community Support            ____ Help for Those in Impoverished Circumstances (Homelessness, Lack of Food or Water)

____ Other: _____________________________________________________________________________________________________________________

  1. Which of the following best describes on what level the funds will be used? (Please check all that apply)

____ Local (In the Colorado Springs or surrounding area)

____ National (What region or states?) ______________________________________________________________________________________________________________________________

____ International (What country or countries?)______________________________________________________________________________________________________________________

  1. How will funds be used? (Please describe, if more room is needed attach another page) ___________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________

  1. How much are you requesting (if a specific amount is not needed, please indicate)? ________________________________________________________________________________________

 

Outreach Team Use Only:

Request Review Date: ____________________________________         Request Decision (please circle):           Approved        Denied          More Information Needed

Funding Amount Approved: ______________________________          Duration of Funding (please circle):     One-time         Monthly        Annual