Change for a Dollar

Nominee Information

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail

Marital Status*

SingleMarriedDivorcedSeparated

If married, name of spouse

Name(s) and age(s) of child(ren) living in the home

Has this person been nominated before?*

YesNoUnknown

Does this person attend church?*

YesNo

If "yes", Where do they attend?

Please be as specific as possible when completing the following:

What is the immediate financial need? If you are able, please include amounts, to whom the funds are owed, and any other information that will benefit the team in making its decision.*

Please describe the recipient’s overall life situation as specifically as possible. Again, please include any information that might help the Change for a Dollar team.*

How would this gift make a lasting change in the recipient’s life?*

Please provide YOUR information

Full Name*

First NameLast Name

Your relationship to the nominee*

Do you attend MPCC?*

YesNo

Does the Nominee have knowledge that you are submitting their name(s) for this grant?*

YesNo

How did you become familiar with Change for a Dollar?*

E-mail*

Phone Number*

Area CodePhone Number

Thank you for completing this nomination.
Please do not contact anyone at the church with questions on the status of your application. Please know that the deciding committee is prayerfully and thoughtfully considering each nominee. We ask that you pray for the wisdom and guidance of this ministry and for the individuals entrusted with making these decisions.

NOTE: If you do not hear from us within two weeks of the nomination deadline, then we have decided to assist another request. Nominations are not rolled over; however you may submit this request again!

Change for a Dollar Nomination