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Financial Support Form
2024 Financial Support Data Form for Agencies
DUE: AUGUST 15, 2023 All information will be kept confidential.
Agency
(Required)
Worker name
(Required)
First
Last
Worker email
(Required)
Worker cell phone
(Required)
Name of worker's spouse (if applicable)
First
Last
Did the worker receive full support for 2022?
(Required)
Yes
No
What percentage or support level did the worker receive?
(Required)
Enter a percentage or dollar amount
Annual target support level set by agency for 2023:
(Required)
What percentage support do you expect the worker to receive for 2023?
(Required)
Enter a number from 1 to 100
Do you anticipate any changes in support level for 2024?
Yes
No
Please explain.
(Required)
Did the worker receive income from a separate source other than donations through your agency?
Yes
No
Please list all sources of income:
(Required)
Please explain and include what percentage of your living and ministry expenses are being supplied by this income.
(Required)
Does the worker have a job outside of your agency?
(Required)
Yes
No
Does the worker receive Social Security benefits and/or a pension?
(Required)
Yes
No
Are you aware if the worker currently has any unusual or unexpected needs (medical, vehicle, travel, etc.)?
(Required)
Yes
No
Please specify:
(Required)
Does worker expect to retire in 2023 or 2024?
(Required)
Yes
No
What month and year?
I hereby submit the above information:
Name
First
Last
Email
Phone
Name
This field is for validation purposes and should be left unchanged.