REQUEST FOR FUNDING FROM THE OUTREACH ENDOWMENT COMMITTEE
1620 Turner Street, Allentown, PA 18102
610-434-0155, Fax 610-434-6306 E-mail mediatorec@verizon.net
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Request Date: |
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Requested for (Agency/Organization & Program Name): |
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Name of Organization: |
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Address: |
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Agency/Organization Contact Person: |
Name: Phone Number: E-mail: |
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Amount requested for this year: |
$ |
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Amount awarded last year: |
$ |
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Program Description Summary e.g. Target clients (age, location, condition), program objective, method of service delivery, time in existence: |
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How does the agency/organization evaluate the impact of the program on its clients? |
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Briefly describe the program’s impact on its clients over the past two years: |
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How would a Church of the Mediator contribution be utilized? |
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If a Mediator Endowment grant was awarded in the past two years, please describe how this money was used: |
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Is additional information attached? |
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Will the agency/organization will provide a 250-500 word article for the Mediator newsletter describing the impact of this program on its clients? |
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Recommended by: (Parishioner’s Name) |
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Parishioner Relationship to Organization: |