Request Form Form for HPBC Churches requesting money. Requests must be done at least 60 days prior to date of event. Date* MM slash DD slash YYYY Contact InformationContact Name* First Last Title (Pastor, Youth Leader, Missions Leader, etc)* Phone*Email* Church InformationFederal 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 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:* Evangelism / Evangelism Training Sue Nishikawa Offering Name of event/project/ministry:* Date(s) of event/project OR if on-going, list schedule or event dates and times:* Your Estimated Cost:* Breakdown of expenditures: (Example: $25-promotional items, $25-prizes for games, $50-rental of bouncy house, $50-food)*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?*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 Director By 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 Church* MM slash DD slash YYYY