Referral Form

We specialize in facilitating high-impact projects that bring refreshment to the personal needs of ministry leaders. Do you know someone who could use this kind of encouragement? Please take 2 minutes to fill out a short referral form. If approved, we will work hard to bless this minister in a significant way. REVfresh is not able to provide support for a person who needs restoration back into ministry, addiction or trauma recovery, on-going counseling, or emergency medical attention.

REVfresh gives focus to those at higher risk of burnout and dropping out of ministry. We love to fund black, indigenous, people of color, women and other minorities. We also prioritize both urban and rural settings and those in lower income situations.

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* 1. Your Full Name

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* 2. Your Email Address

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* 3. Your Phone Number

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* 4. I am apart of a partner organization with REVfresh

Minnesota Assemblies of God

South Dakota Assemblies of God

Iowa Assemblies of God

National Evangelist of the Assemblies of God

Other (please specify your network)

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* 5. Referral's Full Name

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* 6. Referral's Email Address

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* 7. Referral's Phone Number

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* 8. Referral's Place of Ministry

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* 9. What Denomination or Fellowship is the Candidate apart of?

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* 10. Please Select the age range of the person being referred

18-24

25-34

35-44

45-54

55-64

65+

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* 11. Why are you recommending this person?

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* 12. Would you or your ministry be interested in donating to this project?

Yes