For Grant from the Good Samaritan Fund (GSF)

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ECC Care Ministry Application For grant from the Good Samaritan Fund (GSF)

Instructions: Please enter information in each text box. Grant requests up to $1,000 dollars per month are submitted through the Congregational Council. Grant requests above$1,000 are submitted directly to the Care Ministry Committee (CMC).

Date: Campus: SEATTLE: REDMOND: Individual or Organization: Individual: Organization: Name(s) of Applicant:

Address: City State Zip If Individual, please give details of family size, members, parents, children and their ages. If Organization, please provide web site (if available) and pertinent details on method of giving.

Amount requested: ECC member(s) making recommendation: Ministry/Fellowship/Small group: Congregation: Please state the reason for grant request: Job situation: Health: Relief Worldwide Relief Local Background and Further Details (Please use additional pages, attachments as required):

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ECC CM GRANT APPROVAL PROCESS. (Refer to ECC CM policy for vetting criteria details.) ------Amounts above $1,000 dollars require review by the Care Ministry Committee (CMC) and approval by two ECC Church Board members. Amounts up to $1,000 dollars per month per applicant may be approved by Council Chairperson for up to two months. Subsequent grants to the same applicant are subject to review by the CMC. Initial Approval: Final Approval:

1st Church Board Member 2nd Church Board Member

ECC Care Ministry and Administrative Review: (ECC church use only)

Date Reviewed by CMC: ______

EB review necessary? ______Decision:______

CMC Recommendation: ______

ECC Finance Department Administrative Review: (ECC church use only)

Report by: ______1. Confirm Care Ministry Application form is in order:______2. Confirm Check Advance Request form is in order:______3. Provide scanned copy of check and approved forms to ECC CM Chair:______4. Provide scanned copy of receipt from agency to ECC CM Chair:______(Word 97-2003 .doc)

Application to support Humanitarian Projects Thank you for applying to the Good Samaritan Fund. The intent of the Good Samaritan Fund is to support humanitarian projects in communities within our neighborhood, in our country or abroad. Due to the source of the funding, the work supported by the Good Samaritan Fund must be primarily directed towards meeting the physical, financial, social and emotional needs in communities, in so doing demonstrate God’s love for all people. The source of these funding prohibit its use in proselytizing. We (or I) understand the intent of the use of this grant and agree with the conditions of the policy: Responsible Applicant Signature: Date:

------Specific instructions for name and address for funds via check from ECC Finance. Applicant Organization Name: Applicant Organization Address: Responsible Applicant Name: (Last, First MI) Address: Phone: Fax: Contact email address: Organization website: Does the applicant organization publish financial accountability? If so, please indicate where it is published? Website:

Proposed Project:

Dates From (month, year): To (month, year): Project Duration: Brief description of project:

Where is the project being carried out? What are the humanitarian objectives of this project? 1. 2. 3. (Word 97-2003 .doc)

Please use the table on the next page to provide specific details for funds to be used with this project. This is for accountability with our donors.

Please itemize each item of the project for fund is requested by completing the table below: No. Item Description of Use Amount example 1000 lbs of rice Feeding 100 families for a month $500.00

Total Amount Requested: ______------