St. Matthias Episcopal Church

Outreach Funding Application

Mail Completed Form to:

St. Matthias Episcopal Church

574 W. Montrose Street

Clermont, FL 34711

Phone: 352-394-3855

Organization Name: _______________________________________________________
Address: ________________________________________________________________
Telephone: _____________________________  Fax: ____________________________
Email: __________________________________________________________________


Brief History of agency/organization (attach additional sheet if necessary):
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Geographical area served: __________________________________________________
Type of population served: _________________________________________________
What is your agency's relationship with St. Matthias and/or the Episcopal Diocese of Central Florida, if any?
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Have you received funds from St. Matthias previously? _____________
If yes, how much? _________________ What year(s)? __________________________
please scroll to the next page

St. Matthias Episcopal Church Outreach Grant Application, page 2
Does your agency receive funds from the United Way or other funding sources? Describe
all sources of funding for the two preceding fiscal years.
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Please describe the purpose/activity/program for which you are requesting funding:
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Is the above an operating expense? _______________________
Is this request for a one-time program or an on-going program? ___________________
Is your agency familiar with any St. Matthias members? ____________ If yes, whom?
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Is this person an employee, volunteer or fund-raiser, etc. for your agency? ____________
Please list Board or advisory persons, if any: _____________________________________________________________________
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St. Matthias reserves the right to request follow-up information regarding usage of any funds which may be granted.


Your Name & Position: ___________________________________________________
Signature: _________________________________________ Date: ________________