Share Fund - Mutual Aid Agency

Name of Congregation

EIN of Congregation

Name of Recipient Needing Assistance

Provide a brief description of the concern:

State the income situation of the individual for which assistance is requested. This should include past, present and possible future income.

3. Give a brief description of ways the congregation currently is working at this problem, financially and otherwise. (Please attach photocopy of the check(s) issued by the Congregation, made payable to the applicant.)

Photocopy of check

Give other sources of income (i.e. family, friends and community or government funds.)

Other information that might be helpful during the approval process.

Name of person completeing this form

Position in the Church

Telephone Number

Church Mailing Address

City

State

Zip Code

Full Name (electronic signature)

Date

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Assisting eligible congregations, camps and related ministries by providing matching funds for individuals in crisis.