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Missions Resource Request Form

"... that you and I may be mutually encouraged by each other's faith. " - Romans 1:12

Missions Resource Request Form

GENERAL INFORMATION
• Instructions are provided to the right of this form.
• All fields must be completed; use "n/a" for fields not applicable to your application.

ORGANIZATION INFORMATION

Name of Organization

Address

Address (Line 2)

City/State/Zip

Website Address

Telephone Number

Fax Number

Email Address

Theological Tradition

Chief Administrative Officer

Contact Person

Position

MISSION
In the space below, please provide the mission statement/primary purpose of your organization.

Mission

RESOURCE REQUEST SUMMARY
In the space below, please provide a summary of your request.

Request

VPC MEMBER INVOLVEMENT
Current VPC Member Involvement:
Identify current involvement in each of the three areas below, as appropriate:

Committee Involvement

Volunteer Involvement

Other (Please specify)

Proposed VPC Member Involvement:

Proposed Involvement

DETAILED RESOURCE REQUEST
Please provide a description of each area below that pertains to your request:

Prayer

Financial

Materials

Use of Facilities

Volunteer Needs

YOUR RESOURCE BASE

Number of Clients Served Annually

Number of Employees

Number of Volunteers

Annual Budget

Source of Funds (Identify % from each source):

Individuals

Churches

Foundations

Program Fees

Government

Other
(Identify each and %)

OTHER PERTINENT INFORMATION
Please provide any other pertinent information in the space below.

Additional Information

FINAL REVIEW
• Please review all information entered above for accuracy.
• You may want to print a copy of this application for your records.
• When finished, click the "Submit" button below; or, use your browser's Back button or
select from the menus to cancel.

Instructions

• Please note that all fields on the form must have an entry. If a field does not apply to your application, you must enter "n/a" for that field.

• Be as complete as possible with your responses.

• When finished, please review all information for accuracy and completeness. You may wish to print a copy for your records.

• Click the Submit button at the bottom of the form to send your information to VPC. Use you browser's Back button to cancel submission.

• For more information contact Sheila Breuer, Director of Missions, at 703-938-9050 x113, or sheila.breuer@viennapres.org.

Vienna Presbyterian Church

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Missions Resource Request Form

Missions Resource Request Form

GENERAL INFORMATION• Instructions are provided to the right of this form.• All fields must be completed; use "n/a" for fields not applicable to your application.

ORGANIZATION INFORMATION

MISSIONIn the space below, please provide the mission statement/primary purpose of your organization.

RESOURCE REQUEST SUMMARYIn the space below, please provide a summary of your request.

VPC MEMBER INVOLVEMENTCurrent VPC Member Involvement:Identify current involvement in each of the three areas below, as appropriate:

Proposed VPC Member Involvement:

DETAILED RESOURCE REQUESTPlease provide a description of each area below that pertains to your request:

YOUR RESOURCE BASE

Source of Funds (Identify % from each source):

OTHER PERTINENT INFORMATIONPlease provide any other pertinent information in the space below.

FINAL REVIEW• Please review all information entered above for accuracy.• You may want to print a copy of this application for your records.• When finished, click the "Submit" button below; or, use your browser's Back button or select from the menus to cancel.

Instructions

GENERAL INFORMATION
• Instructions are provided to the right of this form.
• All fields must be completed; use "n/a" for fields not applicable to your application.

MISSION
In the space below, please provide the mission statement/primary purpose of your organization.

RESOURCE REQUEST SUMMARY
In the space below, please provide a summary of your request.

VPC MEMBER INVOLVEMENT
Current VPC Member Involvement:
Identify current involvement in each of the three areas below, as appropriate:

DETAILED RESOURCE REQUEST
Please provide a description of each area below that pertains to your request:

OTHER PERTINENT INFORMATION
Please provide any other pertinent information in the space below.

FINAL REVIEW
• Please review all information entered above for accuracy.
• You may want to print a copy of this application for your records.
• When finished, click the "Submit" button below; or, use your browser's Back button or
select from the menus to cancel.