2021 MNA Ethnos Coalition Relief Funds Grant Application

2021 MNA ETHNOS COALITION COVID 19 RELIEF FUNDS GRANT APPLICATION

Guidelines for Diaconates applying for help:
Our objective is to give immediate food and shelter relief for COVID-19 distressed low-income households (those with previous net annual incomes of $35,000 or less, or up to $48,000 for households larger than 4) as follows:

1. Food
• Family food stipend based on family size

o Up to $300 for families of 2
o Up to $600 for families of 3 and 4
o Up to $900 for families of 5 or more

• Re-stock program. Deacons receive money to purchase food for their mercy pantry

o $1,000 for churches of 100 or less
o $2,000 for churches of 100 – 200
o $3,000 for churches of over 200

2. Shelter
• Rental Assistance paid directly to the landlord

o Up to $2,000 per family

3. Mental Health Counseling
• Mental Health Counseling Assistance paid directly to the service provider

o Up to $2,000 per family

4. Funeral Expenses
• Funeral Expenses Assistance paid directly to the service provider.

o Up to $2,000 per family

APPLICATION DATE *

CHURCH AND PASTOR INFORMATION

Church Name *

Church Address

City *

State *

Zip/Postal Code *

Average Church Attendance *

Pastor First Name *

Pastor Last Name *

Cell Phone *

Email Address *

IF YOU ARE A SMALL CHURCH WITHOUT A DIACONATE, PLEASE SKIP THIS SECTION

Diaconate First Name

Diaconate Last Name

Diaconate Cell Phone Number

**FUND REQUEST SECTION: REFER TO THE RELIEF DISBURSEMENT GUIDELINES BEF0RE COMPLETING THIS SECTION.

How many families do you anticipate will receive help from this relief grant? *

Are any of the above families eligible and likely to receive federal stimulus relief funds or unemployment insurance payments? *

How many? *

Total amount solicited for food stipends for families. *

Total amount solicited for re-stock program for church mercy pantry. *

Total amount solicited for rental assistance. *

Total amount solicited for utility assistance. *

Total amount solicited for mental health counseling assistance. *

Total amount solicited for funeral expenses assistance. *

Grand total amount applying for COVID-19 Relief Grant? (Not to exceed $7000.00) *

We agree to use these COVID-19 relief grant funds in accordance with the Ethnos Coalition guidelines exclusively to help distressed low-income minority households with food and shelter and not for other church expenses. We understand that these funds are meant to expand and enhance, not replace, our church's own commitment to give generously and sacrifically to serve those in need. *

Pastor's Name (Typed) *

Pastor's Signature Date *

Pastor's Signature *

Diaconate Chairman's Name (Typed)

Diaconate Chairman's Signature Date

Diaconate Chairman's Signature

PDF File

Agreement Status

Last Agreement Event

Last Agreement Event Description

Last Agreement Event Date

Agreement documentKey

Agreement VersionKey

Agreement ProfileID

Signing URL Query String

Agreement Expiration

2021 MNA ETHNOS COALITION COVID 19 RELIEF FUNDS GRANT APPLICATION

o Up to $300 for families of 2 o Up to $600 for families of 3 and 4 o Up to $900 for families of 5 or more

• Re-stock program. Deacons receive money to purchase food for their mercy pantry

o $1,000 for churches of 100 or less o $2,000 for churches of 100 – 200 o $3,000 for churches of over 200

2. Shelter • Rental Assistance paid directly to the landlord

o Up to $2,000 per family

3. Mental Health Counseling • Mental Health Counseling Assistance paid directly to the service provider

o Up to $2,000 per family

4. Funeral Expenses • Funeral Expenses Assistance paid directly to the service provider.

o Up to $2,000 per family

o Up to $300 for families of 2
o Up to $600 for families of 3 and 4
o Up to $900 for families of 5 or more

o $1,000 for churches of 100 or less
o $2,000 for churches of 100 – 200
o $3,000 for churches of over 200

2. Shelter
• Rental Assistance paid directly to the landlord

3. Mental Health Counseling
• Mental Health Counseling Assistance paid directly to the service provider

4. Funeral Expenses
• Funeral Expenses Assistance paid directly to the service provider.