For all entries, allow space to expand to accommodate your response. Please be as succinct as possible. Do not leave any section blank. If the information is not available or not applicable, enter ‘NA.’
Name of Ministry/Program:
Sponsoring Congregation & City:
Request Approved by Vestry/Bishop’s Committee at meeting held on _____________.
Request Approved by Deanery at meeting held on ________________.
Deanery Ranking _______________
Area of Ministry or Service: Describe how your ministry or program supports the funding priorities of poverty or outreach established by the Poverty and Outreach Board. You need not support all of the priorities to be considered.
Amount of Grant requested from Poverty & Outreach $
Enter an "X" to indicate the level of impact on the Ministry/Program if the requested funds are not received: Please make a genuine assessment. Requests that are small fractions of a program's budget will be considered if a specific activity is identified for support.
Minimal: Moderate: Significant Without this funding program will be terminated:
Briefly describe the primary goal of the Ministry/Program. Clear, specific goals are preferred. In order to maximize the impact of POB funds, a well-targeted effort is preferred over broader programs. Even better is a well-targeted effort that has positive secondary benefits.
Briefly describe participation in Ministry/Program by sponsoring congregation. The sponsoring congregation does not need to be the primary contributor to the activity. Evidence that the congregation sees the activity as a significant ministry is desired.
Indicate percent of the total revenue provided by sponsoring congregation: %.
How will the funds provided be used to achieve the goal of the Ministry/Program? Clear, specific links between the funding and a particular goal are desired.
Enter the number of individuals who will be served by the funds.
Who will be served by the Ministry/Program and how will they benefit? Be as specific as possible.
Describe the future plans for this Ministry/Program, if applicable. The POB is interested in whether or not the funds provided are meant as seed money for a larger, stand-alone effort or if ongoing support will be required. Either may be appropriate depending on the nature of the Ministry/Program.
Provide any other information the POB should consider with respect to this request. Confirm adequate liability insurance coverage (provider, amount, expiration date) in this section.
Please insert (paste) below the requested financial information for your Ministry/Program, following the templates found as appendices to this application. Information should be summarized, not provided as full detailed statements. DO NOT ATTACH STATEMENTS AS "FILES" as these are difficult for evaluators to open and review.
Budget for Coming Year (this Funding Request year):
Current Revenue & Expenses (Year-to-Date for current year), if applicable:
Revenue & Expenses (for Prior Year of operation), if applicable:
Contact Person for Ministry/Program:
Name to Appear on Checks Sent to Ministry/Program:
Mailing Address to Which Checks Should be Sent:
Poverty and Outreach Board Action on ________________
Approved Denied Amount of POB Grant Awarded: $_____________