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Last Updated: Apr 12th, 2007 - 10:09:43 |
Request for Diocesan Mission and Vision Support
Date: __________________
Person Requesting Funding: __________________________________
Parish: ____________________
Address:
_________________________________
_________________________________
E-Mail: _______________________________
Tel. #: _________________________________
Total Amount Requested $____________
Date Needed ___________________________
The request is for
___Direct Payment
___Reimbursement [Attach all Receipts]
Send Payment/Make out Check to:
___________________________________________
Address:
___________________________________________
___________________________________________
Name of Contact Person
(if different from Payee): __________________________
Telephone: _________________
Description of Request:
____________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________
_______________________________________________________________
Expected Impact on local community, parish and greater community:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
To which area of ministry does this best apply?
___Outreach ___Evangelism ___Youth and Young Adult
Signature _____________________________________
If necessary use the back of the form for additional information.
Send to:
Re-Imagining Advisory Team
Attn: Margaret Porter
63 Green Street
Concord, New Hampshire 03301
Phone: 603 244 1914
Fax: 603 225 7884
www.nhepiscopal.org
© Copyright 2004-2006 by The Diocese of New Hampshire, The Episcopal Church
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