Central Snohomish County Chapter TFL DATE
“Care Abounds in Communities” Program Funding Request

Recipient Info:
Name of Recipient (first, middle, last): _______________________________________________________
Address: ________________________________________
City, State, Zip: _________________________
Recipient Type: ___ Individual; ___ Sponsored Grp of Ind; ___ 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
__ Education __ Food/Hunger __ New Construction __ Supplies
__ Elderly __ General Living __ Religious/Worship __ Utility
Estimated Activity Info:
Date of Activity: ______Type of Activity: ___ Fundraising; ___ Hands-on Service.
Describe the activity in detail (Discuss the activities, goals, estimate of dollars raised and volunteer hours. Use backside of form, if necessary):
Estimated Thrivent member households involved: ________

Names of six involved Thrivent households (the six must be different):
1) ______________________4) __________________________
2) _____________________ 5) __________________________
3) _____________________ 6) __________________________
Funding Info:
For Fundraising Activities: Estimated Net Funds to be raised: $________
Or For Hands-on Service Activity Estimated costs: $___________
Pre-Funding Request for Hands-on Service Activity Only (up to 50%): $_____________
Who gets the Pre-funding: ______________________________________
Address: _____________________________________
City, State, Zip: ______________________
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
Only submit if there will be, at least, 30 days between your planned event & the next Chapter Board Meeting!

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

Central Snohomish County Chapter TFL
Funding Activity Results Summary “Care Abounds in Communities” Program
Actual Date of Activity: ____________
Name of Activity:
Actual Funding Info:
Fundraising Actual Net Funds raised: $_______________
Hands-on 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 + Preparation hours + Event hours + Cleanup hours =
Total: __________Volunteer Hours
Attendance (if applicable):
Thrivent members attending: _______
Thrivent households attending: _______
Total persons attending: _______
CST reporter printed name: _________________Signature________________
Check List of Stuff to send with Summary:
Send no cash.
The Net amount of funds raised above must match the amount of checks included with this form.
Checks for fundraisers and appeals/collections are made to Central Snohomish County 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.

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.
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.
Send this Funding Activity Results Summary to: Central Snoh Co Chapter by Email: NIEL1919@aol.com, or 828 Wetmore Ave,Everett, WA 98201 Voicemail: 425-252-2327