Lifeline Fund Application Phase 2

Lifeline Fund Application Phase 2
Education Debt Relief
PLEASE COMPLETE ALL RELEVANT FIELDS.
Today's Date

MonthDay Year
Date
Name*

First Name Last Name
Address*

Address
Address Line 2
City State / Province
Postal / Zip Code
Phone Number*

Area Code Phone Number
Work Phone

Area Code Phone Number
Email*
example@example.com
To complete this form later, you can click SAVE at the bottom of this page or anytime on subsequent pages. Otherwise click NEXT.

Include ALL EDUCATION LOANS
Note: Be sure to fill in "Initial Loan Amt." & "Projected Loan Payoff Date" for all loans.
Lender Min Mo. Payments Current Mo. Payments Initial Loan Amt. Current Loan Balance Interest Rate Projected Loan Payoff Date
1
2
3
4
5

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Have you filled in all the columns for each loan? If not, go back before continuing.*

Yes

Name & location of congregation you are currently serving:*
ex: Christ the King, Charlotte
Your Synod*
Choose from drop down list
List the following components of your compensation for the current year:*
My defined compensation is*

above guidelines.below guidelines.at guidelinesI don't know.
What is your total household income? $*
(includes your spouse’s income and other sources of income, e.g., second job,disability, alimony, etc)

Debt Obligations
INCLUDE ALL DEBT AS THAT INFORMATION IS USED TO DETERMINE THE AMOUNT OF YOUR AWARD.
Mo. Pmt. $ Outstanding Bal. $ Interest Rate %
Mortgage
Car loan #1
Car loan #2
Credit Card #1
Credit Card #2
Credit Card #3
Credit Card #4
Education loan #1
Education loan #2
Education loan #3
Education loan #4

Details to pay your EDUCATION DEBT—If more than one lender is to be paid, you must indicate how you want lender(s) paid (who gets what in what order).
Loan #1 Lender
Name of Lender
Loan #1 Account Number
Loan # 1 Address to mail payment

Address
Address Line 2
City State / Province
Postal / Zip Code
Special notes: Include a ONE PAGE SUMMARY of the last 12 months of payments made
Upload summary here

Browse Files
Allowed files: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zipCancelof

Loan #2 Lender
Name of Lender
Loan #2 Account Number
Loan #2 Address to mail payment

Address
Address Line 2
City State / Province
Postal / Zip Code
Special notes: Include a ONE-PAGE SUMMARY of the last 12 months of payments made
Upload summary here

Browse Files
Allowed files: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zipCancelof

Loan #3 Lender
Name of Lender
Loan #3 Account Number
Loan #3 Address to mail payment

Address
Address Line 2
City State / Province
Postal / Zip Code
Special notes: Include a ONE-PAGE SUMMARY of the last 12 months of payments made
Upload summary here

Browse Files
Allowed files: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zipCancelof

Loan #4 Lender
Name of Lender
Loan #4 Account Number
Loan #4 Address to mail payment

Address
Address Line 2
City State / Province
Postal / Zip Code
Special notes: Include a ONE-PAGE SUMMARY of the last 12 months of payments made
Upload summary here

Browse Files
Allowed files: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zipCancelof

Have you uploaded a summary for EACH loan listed above? If not, please go back and do so.*

Yes
To which account shall we send your Lifeline Grant? Check for accuracy!
Choose one of the accounts listed above.

Congregation/Position Contact Name (not pastor)

First Name Last Name
Position
Contact Phone

Area Code Phone Number
l understand I will be contacted by Pastor John Mocko to review my application prior to the next meeting of the Distribution Team in my synod, who review and make decisions on awards.*

I understand and agree.
I affirm that the facts set forth in it are true and complete. I understand that if I receive an award, any false statements, omissions, or other misrepresentations made by me on this application may result in retraction of the award.*

I understand and agree.
Attach additional information if necessary

Browse Files
Cancelof
I have answered all required questions and uploaded all summary documents.*

Yes
You're done. Click SUBMIT.

(you can also click the "Print Form" button to print your submission.)
Should be Empty:

Include ALL EDUCATION LOANS