Request Form Form for HPBC Churches requesting money. INFORMATIONDate* Contact Name* First Last Association/Church Title*Phone*Email* Federal Tax ID number of the church:The Tax Identification Number, usually the EIN (Employer Identification Number), MUST be the number for the organization to whom the check is to be made payable.Name of Association/Church*Church or Church Plant?*ChurchChurch PlantMailing Address* Street Address City State / Province / Region ZIP / Postal Code Check will be mailed to this addressOur church is affiliated with:* Hawaii Pacific Baptist Convention Association FUND REQUESTApplying for:* Evangelistic Ministries/Healthy Church State/Association Ministries Name of event/project/ministry:*Date(s) of event/project OR if on-going, list schedule or event dates and times:*If you receive approval of funds, how do you plan to spend it?*Your Estimated Cost:*Local Church Participation:*Association Participation:*AMOUNT OF REQUEST:*Our church has made contributions to:* Cooperative Program Hawaii Pacific Missions ADDITIONAL INFORMATIONWhat is your Plan of Action in executing an effective event? (include a detailed budget)*How will this assistance help impact your local church?*Do you plan to have evangelism training?*What is the likely result in your community? (ie. 3 salvations, 5 gospel presentations, etc.)*Do you need help or partners for your event?*SIGNATURES OF APPROVALSignature of Pastor, Moderator or DirectorBy typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.Date approved by Sponsoring Church* For HPBC Office Use:Account Evangelistic Ministry (9002) State/Assoc (9001) NeighborhoodCommunitiesYouth/ChildrenFollow Up: Report received Photos received Date received