C.A.R.E. for Pastor Grant Initiative Cohort 6

Application

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1. First Name: (Required.)

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2. Last Name: (Required.)

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3. Gender: (Required.)

Female

Male

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4. Age (Required.)

60+

50-59

less than 50

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5. Home address: (Required.)

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6. Parsonage: (Required.)

Yes

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7. Home Number: (Required.)

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8. Cell Phone Number: (Required.)

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9. Preferred email: (Required.)

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10. Education (highest achieved): (Required.)

High School

Bachelor’s

Master’s

Doctorate

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11. Household: (Required.)

Single

Single w/ Dependent Children

Married

Married w/ Dependent Children

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12. # in Household (Required.)

One

Two

Three

Four

More than Four

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13. Church name: (Required.)

Church address:

City

State

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14. Episcopal District (Required.)

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15. Is Church setting (Required.)

Rural

Urban

Suburban

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16. # of years ordained: (Required.)

1-5

6-10

11-20

21+

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17. # of years pastoring: (Required.)

1-5

6-10

11-20

21+

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18. Church Size (Required.)

0 - 100

100 - 250

251 - 500

501 - 1,000

1000+

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19. Total compensation from church including housing allowance (parsonage = $10,000/year): (Required.)

Less than $25,000

$25,000 - $50,000

more than $50,000

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20. Total compensation of household including spouse and housing allowance: (Required.)

Less than $50,000

$50,000 - $100,000

more than $100,000

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21. Church Employment (Required.)

Full Time

Part Time

Single Vocation

Bi-Vocational

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22. Does the Church take taxes out of your income? (Required.)

Yes

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23. Do you pay self-employment for Social Security on your Church Income? (Required.)

Yes

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24. Does the Church provide Health Insurance? (Required.)

Yes

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25. Do you have Health Insurance? (Required.)

Yes

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26. Does the Church provide Life Insurance (Required.)

Yes

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27. Do you have Life Insurance? (Required.)

Yes

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28. Does the Church provide Retirement Benefits (Required.)

Yes

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29. Do you receive Medicare Benefits? (Required.)

Yes

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30. Do you have a Will? (Required.)

Yes

C.A.R.E. for Pastor Grant Initiative Cohort 6

Application

Question Title

* 1. First Name: (Required.)

Question Title

* 2. Last Name: (Required.)

Question Title

* 3. Gender: (Required.)

Question Title

* 4. Age (Required.)

Question Title

* 5. Home address: (Required.)

Question Title

* 6. Parsonage: (Required.)

Question Title

* 7. Home Number: (Required.)

Question Title

* 8. Cell Phone Number: (Required.)

Question Title

* 9. Preferred email: (Required.)

Question Title

* 10. Education (highest achieved): (Required.)

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* 11. Household: (Required.)

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* 12. # in Household (Required.)

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* 13. Church name: (Required.)

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* 14. Episcopal District (Required.)

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* 15. Is Church setting (Required.)

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* 16. # of years ordained: (Required.)

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* 17. # of years pastoring: (Required.)

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* 18. Church Size (Required.)

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* 19. Total compensation from church including housing allowance (parsonage = $10,000/year): (Required.)

Question Title

* 20. Total compensation of household including spouse and housing allowance: (Required.)

Question Title

* 21. Church Employment (Required.)

Question Title

* 22. Does the Church take taxes out of your income? (Required.)

Question Title

* 23. Do you pay self-employment for Social Security on your Church Income? (Required.)

Question Title

* 24. Does the Church provide Health Insurance? (Required.)

Question Title

* 25. Do you have Health Insurance? (Required.)

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* 26. Does the Church provide Life Insurance (Required.)

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* 27. Do you have Life Insurance? (Required.)

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* 28. Does the Church provide Retirement Benefits (Required.)

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* 29. Do you receive Medicare Benefits? (Required.)

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* 30. Do you have a Will? (Required.)

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* 31. Desired outcome for participation Care-For-The-Pastor program: (Required.)

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* 32. If received, expected use of cash award and why it is needed: (Required.)

1. First Name: (Required.)

2. Last Name: (Required.)

3. Gender: (Required.)

4. Age (Required.)

5. Home address: (Required.)

6. Parsonage: (Required.)

7. Home Number: (Required.)

8. Cell Phone Number: (Required.)

9. Preferred email: (Required.)

10. Education (highest achieved): (Required.)

11. Household: (Required.)

12. # in Household (Required.)

13. Church name: (Required.)

14. Episcopal District (Required.)

15. Is Church setting (Required.)

16. # of years ordained: (Required.)

17. # of years pastoring: (Required.)

18. Church Size (Required.)

19. Total compensation from church including housing allowance (parsonage = $10,000/year): (Required.)

20. Total compensation of household including spouse and housing allowance: (Required.)

21. Church Employment (Required.)

22. Does the Church take taxes out of your income? (Required.)

23. Do you pay self-employment for Social Security on your Church Income? (Required.)

24. Does the Church provide Health Insurance? (Required.)

25. Do you have Health Insurance? (Required.)

26. Does the Church provide Life Insurance (Required.)

27. Do you have Life Insurance? (Required.)

28. Does the Church provide Retirement Benefits (Required.)

29. Do you receive Medicare Benefits? (Required.)

30. Do you have a Will? (Required.)

31. Desired outcome for participation Care-For-The-Pastor program: (Required.)

32. If received, expected use of cash award and why it is needed: (Required.)