Lifeline Fund Application Phase 2

Lifeline Fund Application Phase 2

Education Debt Relief
To expedite your application please complete all relevant fields

You must participate with a financial planner.

You must complete Financial Peace University.

You must provide evidence of 12 months of prior payments made.
Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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

Lender

Min Mo. Payments

Current Mo. Payments

Initial Loan Amt.

Current Loan Balance

Interest Rate

Projected Loan Payoff Date

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. I don't know.
What is your total household income? $ *
What are your total savings and investments that are NOT in ELCA or another company account? *
Add additional savings and investments

Debt Obligations

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

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Special notes: You must 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, zip Cancel of

Loan #2 Lender
Name of Lender
Loan #2 Account Number

Loan #2 Address to mail payment

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Special notes: You must 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, zip Cancel of

Loan #3 Lender
Name of Lender
Loan #3 Account Number

Loan #3 Address to mail payment

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Special notes: You must 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, zip Cancel of

Loan #4 Lender
Name of Lender
Loan #4 Account Number

Loan #4 Address to mail payment

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Special notes: You must 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, zip Cancel of

Contact Name *

First Name Last Name
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

Cancel of
You're done. Click SUBMIT.
Should be Empty:

Lifeline Fund Application Phase 2

Include all EDUCATION LOANS

Debt Obligations

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).

You're done. Click SUBMIT.