Galen Bittner Mission Fund
Request for Funds Application

NOTE: Beginning with applications submitted January 1, 2014, successful applicants will be required to submit a mission report listing the significant accomplishments of the trip as they relate to the trip objectives.  The report shall be submitted within 90 days after completion of the trip. For ongoing mission organizations, a newsletter or periodic update shall be provided.   Failure to comply with this requirement may disqualify the applicant for future awards.    

Attachments included: [  ] Yes[  ] No

1. Organization name and address

2. Church Affiliation

3. Stated purpose of organization.  Objective of mission trip as applicable.

4. Programs and policies for bringing people to Christ

5. Key management or leaders. Names and positions.

6. Significant achievements during last five years.

7. Funds available from other sources.

8.  Amount Requested:  ___________________________            Check payable to: _____________________

9.Address for check :  ________________________________________________________________________

10.  Submitted by:   Name (print) __________________________        Date: _______________

Signature:      __________________________    Tel. __________________ E-Mail _________________

11.  Amount Approved: ______________

Galen Bittner Fund Commission

Name (print) _____________________________ Signature _____________________________      Date: __________

Name (print) _____________________________ Signature _____________________________      Date: __________

Name (print) _____________________________ Signature _____________________________      Date: ___________

Note:  Application cannot be submitted electronicly, but can be printed