Requester's Information Name * Please type in your first and last name. Address * Please type in your address. Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Phone * Please type in your phone number. Email Address Please type in your email address. Requester's Church Information Name * Please type in the name of your church Phone * Please type in your church's daytime phone number. Pastor's Name * Please type in the name of your pastor

Mission Trip Information Location of trip * Please type in the location of the mission that you plan to work Cost * Please type in the total cost of the mission trip. Start Date * Please select the start date. End Date * Please select the end date. Mission Agency * Please type in the name of the mission agency. Agency Address * Please type in the address of the mission agency Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Contact Person * Please type in the name of the contact at the mission agency Phone * Please type in the phone number of the contact at the mission agency.

Other Expected Sources of Support

Support letters to family and friends * Please type in the amount you expect to get by writing letters to friends and family members.
Lutheran Brotherhood/AAL matching funds * Please type in the amount you expect from Lutheran Brotherhood/AAL matching funds
Door offering home church * Please type in the amount you expect from Door offering home church
Scholarship from home church mission board * Please type in the amount you expect from your home church mission board.
Fundraising * Please type in the amount you expect from fund raising.
Personal Funds * Please type in the amount you expect to spend from your personal funds.
Total expected from other sources * Please add up the total amount.
Amount requested from East to West Missions * Please type in the amount you are requesting from East to West Missions.
Date funds required * Please select the date the funds are needed.
Have you previously requested/received an East to West grant? * Please select yes or no if you have previously received a grant from East to West Missions.	Yes No
Are you currently a student?	Yes No
What is the name of your school or college?

Personal Testimony When and where you baptized into Jesus Christ? * Please let us know when you were baptised What do you believe about Him? * Please let us know what your beliefs are. How would you describe your present relationshiip with the Lord? * Please let us know how your relationship is. In which areas of ministry or service are you presently involved in? * How are you involved? Why do you believe the Spirit of God is calling you to go on a short-term mission trip? * Tell us why you believe you should go on this trip What contributions or spiritual gifts could you bring to others on a short-term mission trip? * What gifts do you have to offer? How do you feel a mission trip could affect your future life as a Christian? * How do you think this will affect your future?

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