The Grant Application Period is from September 1 to October 31.

Legal First Name: *

Legal Middle Name: *

Legal Last Name: *

What name do you go by? *

Address: *

City: *

State: *

Postal Code: *

Personal E-mail: *

Home or Cell Phone (xxx-xxx-xxxx): *

Highest educational degree previously received (degree, year): *

Ministerial Status: *

Ordained Clergy

Commissioned Clergy

Congregation Name (or name of employing institution if you are a chaplain or counselor): *

Congregation/Institution Location (city, state): *

Congregation/Office Phone Number (xxx-xxx-xxxx): *

Does your congregation or other church related employer have a policy provision for continuing education time and funds? *

No

Yes

If yes, please describe. Have you applied through them? *

Event/Program Name: *

Event/Program Date including year: *

Event/Program Location: *

Describe the event for which you are seeking funds: please include information regarding how this is educational: *

Sponsoring Institution: *

Event Contact Person Name: *

Event Contact Person Phone Number (xxx-xxx-xxxx): *

Event Contact person E-Mail: *

Will This program apply toward an academic degree? *

No

Yes

If yes, what degree? *

Event/program anticipated date, including year, of completion: *

Is any institution, region or other organization providing CEU credits based on your completion of this program: *

No

Yes

If yes, please provide name of such organization: *

Please briefly and clearly explain how this experience for which you are requesting funds is an educational endeavor and will benefit your ministry (100 words). *

Date and nature of most recent continuing education event/program? *

Have you ever received a continuing education grant from Disciples Home Missions? *

No

Yes

If yes, what year(s) was/were grant(s) received? Please list your legal name when grant(s) was/were awarded. *

Total family income (including housing allowance or 15% of base salary if parsonage is provided): *

Number of exemptions reported for income tax purposes: *

Additional information bearing on financial need:

Tuition or registration fees to be paid to sponsoring institution or organization? *

Additional cost for travel, if any:

Additional cost for lodging, if any:

Additional cost for meals, if any:

Total cost of event/program: *

Amount applicant will personally invest: *

Amount congregation or other church-related employer will invest: *

Amount of scholarship sponsoring-institution and/or other organization(s) will invest: *

Amount requested from Disciples Home Missions (cannot be more than $500): *

Total shared cost: *

If you are human, leave this field blank.

You can learn about Clergy Continuing Education Grants here.