Grant Support Program Application

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

Application for Grant Support Program

The Grant Support Program provides financial assistance with the cost for obtaining a Ministerial Assessment (formerly referred to as a 'Psychological Evaluation').

As a Candidate for Commissioned or Ordained Ministry with the Christian Church (Disciples of Christ) of Mid-America, the following allocation of cost is recommended:

The Candidate pays one-third (1/3).
The Candidate's Congregation pays one-third (1/3).
The Mid-America Region reimburses the Candidate for one-third (1/3).

Next steps: Your Application is sent directly to your Regional Minister for approval. Once approved, the Mid-America Region will mail a check to the address provided on this Application.

Please contact your Ministry Associate in the Springfield Regional Office with questions at sgf@ccmadisciples.org. Thank you so much!

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

Your Regional Minister*

Regional Minister's Email*

Paul@ccmadisciples.org; Phil@ccmadisciples.org; David@ccmadisciples.org; Jennifer@ccmadisciples.org; Angela@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.