REQUEST FORM FOR ENROLLMENT & REIMBURSEMENT
Protocol For Receiving Funds

1. Fill out form and request to be accepted into the Churchill Ministerial Endowment program.
2. This request must be approved by the DBMD.
3. Once 6 credit hours are completed, fill out the same request form to be reimbursed.Also provide a copy of grades and course title. (Send via email, heypastorchad@gmail.com)

Today Date *
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NAME: *
Your answer
ADDRESS: *
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CELL NUMBER: *
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HOME NUMBER: *
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OFFICE NUMBER:
Your answer
EMAIL: *
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WHERE WILL YOU BE ATTENDING: *
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CHURCH SERVING: *
Your answer
CAPACITY/TITLE: *
Your answer
Please list classes completed and requesting funds for: *
Your answer
AMOUNT REQUESTING: *
Your answer
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