Florida Disciples Mission Grant Application Pastor *Person applying *Date of application I affirm that the Pastor is in good standing with the region, meting all requirements of the Commission on Ministry. YESNOCongregation *Church Address *Address Line 1Address Line 2CityState / Province / RegionZip / Postal CodeAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKosovoKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis and FutunaWestern SaharaSamoaYemenZambiaZimbabweCountryPhone *Email *Website INVOLVEMENT OF CONGREGATION IN FLORIDA DISCIPLESOur congregation has been and ACTIVE member of the Florida Regional Church, meeting a MNIMUM of 3 of the following criteria within the past 24 months. Reported to the DOC Yearbook/ALEXSr. Minister has standing and is up to date with required trainingsRepresentatives attended Regional AssemblyHas a partner serving on the Leadership CouncilStudents attended regional campsParticipated in district events or clergy meetingsMembers attended Disciples regional or general church retreats/events (online or in person)Clergy and/or members served on regional task force or committeeContributed financially to Disciples Mission Fund, Disciples Special Day Offerings, the Retreat, the Region, or other Disciples givingOther: Explain FUNDS/RESOURCESAmount requested (max. $1000) *Will you receive funds from any other source for this project? If so please list them. *What is the cost breakdown for this project? Please be specific. *MISSION AND MINISTRYChurch Mission Statement *Purpose of the Grant *Program/project start date *Program/project end date *Program/project target service group *HomelessSeniorsChildren/YouthFeedingLow income assistanceUnchurched (i.e. streaming of worship services)Other: Explain What is the need or problem your program/project addresses? *Describe your program/project. How will it benefit your community? *How does your program/project fit your mission statement? *How does your program/project share the message, ministry, and love and Jesus Christ? *List specific, measurable goals, objective and expected outcomes *Who is responsible for the management of this grant? Are you collaborating with any other organizations on this project/program? Will there be ongoing need for support? How will you address that need? I agree to submit a one-page progress report 6 months from date of award and a final report 12 months from date of award. Please include photos to share with the region. Please submit to: sandy@fldisciples.org or Florida Disciples, 6455 E Silver Springs Blvd, Silver Springs FL 34488. Please note “Grant Progress Report” in heading.Signed [Type your name below to sign this document] MessageSubmit