Applicant Name

Applicant Birthdate (if under 21)

Parent/Guardian Name(s) (if applicable)

Address

Email

Phone

What Church/Community activities do you participate in?

Affiliation with CRUMC (please click one of the below) Affiliation with CRUMC (please click one of the below) Member Regular Attendee Other

Please provide a detailed description of the program/training/seminar of the purpose for which you are requesting funds (provide/include additional information if needed)

Date(s) of the Program

Cost of the Program

How do you feel this will benefit you, your Church and/or your Community?

Would it be difficult for you to participate without financial assistance (click on response) Would it be difficult for you to participate without financial assistance (click on response) Yes No

Optional Comments

I (Applicant) understand that the Foundation will award grants based on the number of requests and available funds. I (Applicant) understand that the Foundation will award grants based on the number of requests and available funds. Yes No

By clicking yes, Applicant agrees this serves as electronic signature. By clicking yes, Applicant agrees this serves as electronic signature. Yes No