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Financial Assistance Grant Request - FCMM

Grant Criteria

1. Applicant Name (Your Name)

2. The EFCA and FCMM have been blessed with matching grant funds to offer retirement account grants to the first 150 EFCA pastors who meet the following criteria:

Space Cell	Yes	No
I am a pastor in an Evangelical Free church, do not currently have an FCMM retirement account, agree to open an FCMM retirement account and my church is participating or is willing to begin participating in the FCMM retirement plan.	I am a pastor in an Evangelical Free church, do not currently have an FCMM retirement account, agree to open an FCMM retirement account and my church is participating or is willing to begin participating in the FCMM retirement plan. : Yes	I am a pastor in an Evangelical Free church, do not currently have an FCMM retirement account, agree to open an FCMM retirement account and my church is participating or is willing to begin participating in the FCMM retirement plan. : No
I have visited NAEfinancialhealth.org/fcmm and previewed (with my spouse, if married) the Bless Your Finances one-session course.	I have visited NAEfinancialhealth.org/fcmm and previewed (with my spouse, if married) the Bless Your Finances one-session course.: Yes	I have visited NAEfinancialhealth.org/fcmm and previewed (with my spouse, if married) the Bless Your Finances one-session course.: No
I have chosen and talked with a designated lay leader who has reviewed this application.	I have chosen and talked with a designated lay leader who has reviewed this application. : Yes	I have chosen and talked with a designated lay leader who has reviewed this application. : No
If approved for a Retirement Matching grant, I agree to complete the Bless Your Finances one-session course (with my spouse, if married). All course work must be completed within nine months from application approval.	If approved for a Retirement Matching grant, I agree to complete the Bless Your Finances one-session course (with my spouse, if married). All course work must be completed within nine months from application approval. : Yes	If approved for a Retirement Matching grant, I agree to complete the Bless Your Finances one-session course (with my spouse, if married). All course work must be completed within nine months from application approval. : No
I will consider the use of a church-wide generosity devotional and consider leadership participation in the Church Generosity course (not required but recommended).	I will consider the use of a church-wide generosity devotional and consider leadership participation in the Church Generosity course (not required but recommended). : Yes	I will consider the use of a church-wide generosity devotional and consider leadership participation in the Church Generosity course (not required but recommended). : No
I will consider distributing the Bless Your Pastor brochure. Some churches may consider receiving an appreciation offering for church staff, utilizing guidelines recommended by the Evangelical Council for Financial Accountability.	I will consider distributing the Bless Your Pastor brochure. Some churches may consider receiving an appreciation offering for church staff, utilizing guidelines recommended by the Evangelical Council for Financial Accountability. : Yes	I will consider distributing the Bless Your Pastor brochure. Some churches may consider receiving an appreciation offering for church staff, utilizing guidelines recommended by the Evangelical Council for Financial Accountability. : No
I understand I will receive the $1,000 matching grant when FCMM receives my Completion Certificate for the Bless Your Finances course and when my new FCMM retirement account reaches $1,000.	I understand I will receive the $1,000 matching grant when FCMM receives my Completion Certificate for the Bless Your Finances course and when my new FCMM retirement account reaches $1,000.: Yes	I understand I will receive the $1,000 matching grant when FCMM receives my Completion Certificate for the Bless Your Finances course and when my new FCMM retirement account reaches $1,000.: No
I will complete my online application at NAEfinancialhealth.org/fcmm and turn in an IRS W9 form.	I will complete my online application at NAEfinancialhealth.org/fcmm and turn in an IRS W9 form.: Yes	I will complete my online application at NAEfinancialhealth.org/fcmm and turn in an IRS W9 form.: No

3. How did you first hear about the Financial Health courses and grant?

4. Please provide the following contact information. All information is required. If not married, in the spouse boxes put the word: no *This question is required.

Space Cell	First Name	Last Name	Area Code/Cell	Email
Pastor	Pastor: First Name	Pastor: Last Name	Pastor: Area Code/Cell	Pastor: Email
Spouse	Spouse: First Name	Spouse: Last Name	Spouse: Area Code/Cell	Spouse: Email
Lay Leader	Lay Leader: First Name	Lay Leader: Last Name	Lay Leader: Area Code/Cell	Lay Leader: Email

5. Please provide the following church information. *This question is required.

Space Cell	Church Name	Worship Attendance	Church Annual Income	Phone w/Area Code
-	-: Church Name	-: Worship Attendance	-: Church Annual Income	-: Phone w/Area Code

6. Please provide the following personal information *This question is required.

Space Cell	Your Age	Your Salary (including housing allowance) From the Church
-	-: Your Age	-: Your Salary (including housing allowance) From the Church

7. Please provide the following mailing information *This question is required.

Space Cell	Names	Address	City, State	Zip
Church	Church: Names	Church: Address	Church: City, State	Church: Zip
Home	Home: Names	Home: Address	Home: City, State	Home: Zip