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Mid Willamette Chapter
Coordinators: These forms are fillable in Adobe Acrobat Reader or may be printed and filled in by hand.

size:751.12 K
Funding Request Questionnaire Form

size:561.62 K
Prefunding Request Form #1 (Appleton)

size:994.24 K
Prefunding Request Form #2 (Board)

size:553.14 K
Report for Funding Activity Results

size:476.25 K
Permission to Disclose Information Form
Those who receive assistance must complete a Permission to Disclose Information form. This signed form provides Thrivent Financial permission to use, disclose and publish the recipient’s name and other related information about the recipient for the purpose of planning, conducting, advertising and communicating the results of an activity for the recipient’s benefit.

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Permission to Disclose Information - Parent/Guardian
A parent, guardian or other legal representative of a minor child or incompetent recipient (one who receives the help) must complete a "Permission to Disclose Information" form. This completed form provides Thrivent Financial for Lutherans with permission to use, disclose and publish the recipient's name and other pertinent information about the recipient for the purposes of planning, conducting, advertising and communicating the results of a fund-raising activity for the recipient's benefit (e.g., to publicize the fund-raising activity).
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Thrivent Financial for Lutherans Contact Thrivent Financial
800-THRIVENT
(800-847-4836)		 Appleton Office:
4321 N. Ballard Road
Appleton, WI 54919-0001 USA		 Minneapolis Office:
625 Fourth Avenue S.
Minneapolis, MN 55415-1624 USA		  
         
Thrivent Financial for Lutherans, Appleton, WI 54919-0001, is authorized to conduct business in all 50 states and the District of Columbia. NAIC # 2938-56014. Products issued by Thrivent Financial for Lutherans are available to applicants who meet membership, insurability, U.S. citizenship and residency requirements. Not all products described are available in all states. Thrivent Financial representatives are licensed insurance agents. Insurance and retirement products, where available, are individual contracts, (not group coverage), and issued by Thrivent Financial for Lutherans. Investment products are offered through Thrivent Investment Management Inc., 625 Fourth Ave. S., Minneapolis, MN 55415-1665, a wholly owned subsidiary of Thrivent Financial for Lutherans. Member FINRA. Member SIPC. Thrivent Financial representatives are registered representatives of Thrivent Investment Management Inc.