Please review our Individual Grant Criteria here before completing the form below. If you have any questions about our Mutual Aid Ministries Individual Grant Request form, please contact us at

* 1. Person Completing This Request

* 2. Are you currently insured by MAX directly, or through one of our independent agents?

* 3. Relationship to Grant Recipient (member of my church, relative, neighbor, friend, etc.)

* 4. Does the Grant Recipient know you are submitting this request on their behalf?