Support Request - Impact Ukraine

Financial Support Request

Name *

First

Last

Church / Organization Name *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

How many members does your church/organization have? *

What are your church's/organization's annual gross revenues? *

What percentage of your gross revenues are used for salaries? *

Is your church/organization financially stable (you earn more than you spend)? *

Briefly describe the primary activities of your church/organization. *

Do require any specific training before you receive money? *

How much money are you requesting (USD)? *

What will you use the money for? *

How many people will be helped? *

Are you asking any other organizations to give money towards this request? *

File Upload (download forms using the links at the top of the page)

Click or drag a file to this area to upload.

You agree to the following *

By checking this box, you agree that the information you have provided is accurate and the money will be used for the purposes described. You allow the board of Impact Ukraine to investigate your personal and professional qualifications. You will need to provide us with your SWIFT banking information and a photo of your passport and you will sign our Financial Support Agreement.

Financial Support Agreement Click to download
SWIFT Banking Information Click to download