ABCD
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Stipend Grant Request
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Use this form to request Stipend Grants. If you need to request an Expense Grant, see Expense Request Form.
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See video instructions for completing this grant request form here.
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See video instructions for completing grant report form here.
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REQUEST STATUS
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DRAFT
To submit this form, please insert a comment at the top of the form and write "submitted" and then press COMMENT. You will receive a reply notification when it has been received. Please check your email for any correspondence about further information that may be needed to process this form in its entirety.
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General Information
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Fund Custodian Name:
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Fund Custodian Email:
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Reliant Church/Project Fund Name:
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Reliant Church/Project Fund Number:
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Attestation
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I have read Reliant's grant standards and have a Master Grant Agreement (as signed in the church/project fund request form) in place. I am committed and agree to utilize grant funds received for the purposes described above and to comply with Reliant's Grant Report requirements. I realize that Reliant requires a report on this project every six months. This report will need to show financial information of how the grant was spent and describe how the church/project is achieving its goals/objectives. Reliant reserves the right to obtain a return of any funds not used for the purposes for which they were granted.
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Reliant Fund Custodian please write "yes" in agreement of the above Attestation:
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Stipend Grant Details
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One-time request or recurring:
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Begin Grant Stipend Disbursement (month/year):
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Describe how the purpose for this grant request aligns with purpose of the fund as outlined in the Master Grant Agreement:
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Have you submitted the banking information?
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direct deposit agreement form
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wire agreement form
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Date of Request Form Submission (cannot be a future date):
Currency exchange rate for request is estimated based on the month of submission.
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Currency for Grant Disbursement (based on receiving bank account):
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If you have a wire agreement, select the corresponding currency. Exact exchange rates will be determined on the date of the wire transfer. If multiple currencies are needed, please submit one form per currency.
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Designated Grantee Details
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Designated Grantee 1Designated Grantee 2Designated Grantee 3
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Legal Name of Designated Grantee:
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Designated Grantee's Relationship to the Ministry:
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Responsibilities of Designated Grantee Related to this Stipend:
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Amount of Stipend (in currency indicated above):
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Subtotal grant stipend request from Additional Designated Grantees Tab:0.00
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TOTAL one-time or recurring request in selected currency:0.00
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TOTAL one-time or recurring request in US dollars:$0.00
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Disbursement Information
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Fund Custodian:
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Pay to Name/Entity:
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 Street Address:
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City, State, and Zip:
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Special Instructions:
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Approvals
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Please type your name in the white box. Then insert a comment that says "Signed" in that box. You can do so by selecting 'Insert' on the menu above and 'Insert Comment'.
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Authorized Signer:
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Date:
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Email Address:
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If your church/ministry fund requires two authorized signers, then share this form with the second authorized signer of the fund to receive their approval before you sharing the filled-out form with the project fundraising team.
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Authorized Signer #2:
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Date:
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Email Address: