Date Submitted:

PROJECT INFORMATION

Title of Project:

Name of Congregation:
Address:

Phone:
Fax:
E-Mail:
Web Address:
Lutheran Church Body:
Name of Senior Pastor:
Name of Congregation President/Chair Person:
Address:

E-Mail:

For further information about this request, contact:

Title (check one): ___ Mr.  ___ Mrs.  ___ Ms.  ___ Rev.  ___ Dr.
Name:
Address:

Phone:
Fax:
E-Mail:

Planned start-up date:

Amount of Request: