Address: ________________________________________ City, State, Zip: _________________________

Recipient Type: ___ Individual; ___ Non-Profit Lutheran Organization; ___ Non-Profit Non-Lutheran Organization
Type of Need:
__ Cash Assistance __ Environmental __ Health/Medical __ Rent __ Youth/Student
__ Disaster Assistance __ Equipment __ Indigent __ Repairs/Maintenance __ Not Applicable
__ Education __ Food/Hunger __ New Construction __ Supplies
__ Elderly __ General Living __ Religious/Worship __ Utility

Activity Info:
Date of Activity: __________________________ Type of Activity: ___ Fundraising; ___ Hands-on Service.

Name of Activity: _______________________________________________________________________
Describe the activity in detail (Discuss the activities, goals, estimate of dollars raised and volunteer hours. Use
backside of form, if necessary):

Estimated Attendance: ________ Thrivent member households; ________ Others attending.
Names of six participating Thrivent households (the six must be different):

1) __________________________________________ 4) ______________________________________

2) __________________________________________ 5) ______________________________________

3) __________________________________________ 6) ______________________________________

Funding Info:
A. for Fundraising Activities:
Estimated Net Funds to be raised: $_______________
B. for Hands-on Service Activities:
Estimated Material Expenses to be incurred: $__________________

Pre-Funding Info: (for Hands-on Service Activities Only). Amount Requested (up to 50%): $_____________

Send Pre-funding to: ________________________________________________

Address: _____________________________________ City, State, Zip: ______________________

Total Thrivent Supplemental Funds being requested (for either A. or B. above): $ ____________________.
(maximum of $800 per each Hands-on Service Activity)

Requestor Info:
Name of Community Service Team Contact: __________________________________________________

Address: ________________________________________ City, State, Zip: _________________________

Phone: ___________________________ Email: ______________________________________________

Email this Funding Request Form to: NIEL1919@aol.com or
Mail request form to Central Snohomish County Chapter, 828 Wetmore Ave, Everett Wa 98201

Please submit at least 60 days before your planned event!

AFTER YOUR EVENT IS COMPLETE USE THIS TO SUBMIT FOR FUNDING:

Funding Activity Results Summary
“Care Abounds in Communities” Program

Activity Info:
Date of Activity: __________________________ Type of Activity: ___ Fundraising ___ Hands-on Service.

Name of Activity: _______________________________________________________________________

Requestor Info:
Name of Community Service Team Contact: __________________________________________________

Address: ________________________________________ City,State,Zip_________________________

Phone: ___________________________ Email: ______________________________________________

Actual Funding Info:
A. for Fundraising Activities:
Actual Net Funds raised: $_______________
B. for Hands-on Service Activities:
Actual Material Expenses incurred: $__________________

(Please submit all net funds raised with this Funding Activity Results Form. See Checklist below.)

Attendance and Volunteer Hours Info:
Volunteer Hours:
Planning _________hours x Number of Persons____ = __________hours
Preparation _______hours x Number of Persons____ = __________hours
Event ____________hours x Number of Persons____ = __________hours
Cleanup __________hours x Number of Persons____ = __________hours
Total: __________Volunteer Hours
Attendance (if applicable):
Thrivent members attending: _______ Thrivent households attending: _______
Total persons attending: _______ Total households attending: _______

Check List of Stuff to send with Summary:

_____ All expense receipts are enclosed. Please report for each expense amount, Date of receipt, Store/Retailer used, name of purchaser, their phone, when & how much they were reimbursed.
_____ Checks for fundraisers and appeals/collections are made to Central Snohomish Chapter and enclosed. If your CST is using another financial account and won’t be sending in the actual checks & deposit slips, include a financial statement from the other account manager reporting what payments were received, when and where it was deposited with the single check for the entire net funds raised.
_____ Send no cash.
_____ The Net amount of funds raised above must match the amount of checks included with
this form.
_____ Include any completed forms for Donations in the amount of $250 or more. Be sure to give
receipts for these contributions to those who contributed.