Application

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. *

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 *

Click or drag a file to this area to upload.

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 completing this form *

Position in the Church *

Telephone Number

Email *

Church Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Signature *

Clear Signature

Date *

When you choose to insure with us, you are also choosing to support the Share Fund. MAA donates a portion of its profits directly to the Share Fund, which means that a percentage of your premium goes directly to those experiencing times of crisis.

For more information on the Share Fund or to request a paper application, please call us at 800-255-1243. Applications can be mailed to 3094 Jeep Road, Abilene, KS 67410 or completed online. Please allow 2-3 weeks for processing.