Grant Support Program Application

The Christian Church (Disciples of Christ) of Mid-America

Application for Grant Support Program

The Grant Support Program was developed specifically for Ministry Candidates pursuing Commissioning or Ordination with the Mid-America Region. This Program provides financial assistance with the cost of obtaining a Ministerial Assessment (formerly referred to as a Psychological Evaluation).

The Mid-America Region recommends the following allocation of cost for a Candidate's Ministerial Assessment:

The Candidate pays 1/3 of the cost to obtain a Ministerial Assessment.
The Candidate's Congregation pays at least 1/3 of the cost to obtain a Ministerial Assessment.
The Mid-America Region reimburses the Candidate 1/3 of the cost to obtain a Ministerial Assessment.

Reimbursement for this program will be provided upon submission of payment and receipt. Once your Application is submitted, it will be emailed to your Regional Minister for approval. Upon approval, the Regional Office will mail you a check to the address provided on this form.

Should you have any questions, please contact your Ministry Associate in the Springfield Regional Office at sgf@ccmadisciples.org. Thank you!

Name*

First NameMiddle NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Home Address (This is where your check will be mailed.)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Requesting Scholarship for (check all that apply):*

Ministerial AssessmentOther

If you are applying for this scholarship for a reason other than completing a Minsiterial Assessment, please explain here.*

Please provide as much detail as possible.

Sponsoring Congregation Information

Sponsoring Congregation*

Name of the Congregation where you serve.

Congregation's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Board Chair's Name*

Board Chair's Email*

example@example.com

Board Chair's Phone Number*

Please enter a valid phone number.

Regional Minister

Your Regional Minister*

Paul KochRon RoutledgePhil SniderDavid Woodard

Regional Minister's Email*

Paul@ccmadisciples.org; Ron@ccmadisciples.org; Phil@ccmadisciples.org; David@ccmadisciples.org

Reimbursement Information

Reimbursement Amount*

Please specify the exact amount to be reimbursed.

Please upload a copy of your paid receipt. *

Please sign your name below in acknowledgement of your Application.