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

2. 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: _________________________________________________________________________________________

3. 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?)______________________________________________________________

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

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

5. 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