Black and Indian Mission Office

Grant Request

To support your Diocese and Parish-level Annual Collection efforts, we are providing the following materials to you for download. Please use this information to help generate awareness and support in your Diocese for the Black and Indian Mission Office:

The following links provide downloadable version of the 2011 Grant Form as well as the Black and Indian Mission School/CCD Grant forms. Downloaded versions may be completed offline and emailed back to info@blackandindianmission.org

The 2011 Grant Application deadline is July 19th, 2011. The form may be downloaded from the link above or completed online below.

Year 2011 Black and Indian Mission Collection Grant Request Form

The following information is used for daily correspondence as well as National Collection mailings so accuracy is important for proper and ontime delivery. Your cooperation with this matter is greatly appreciated. All fields required unless otherwise noted.

Instructions: Please fill out the form below. Once done, please press submit.

1. Arch/Diocese:
Ordinary First Name:
Ordinary Last Name:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:
Phone Number:

2. Auxiliary Bishop(s):
Name:
Email Address:

Name:
Email Address:

Name:
Email Address:

Name:
Email Address:

Name:
Email Address:

3. Chancellor(s):
Title:
First Name:
Last Name:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:

Second Contact:
First Name:
Last Name:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:

4. Director/Person in charge of the Black and Indian Mission Collection at the Chancery:
First Name:
Last Name:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:
Phone:
Fax:

5. Diocesan Newspaper:
Name of Publication:
Editor First Name:
Editor Last Name:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:
Phone:
Fax:

6. Black and Indian Ministry Office Information:
Director's First Name:
Director's Last Name:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:
Diocesan Email:
Ministry Email:
Phone:
Fax:

7. 2012 Collection Date for your Arch/Diocese:
The official date is the first Sunday of Lent - February 26, 2012

8. Type of Collection in your Arch/Diocese:
Single (only for Black and Indian Missions Collection)
No Collection (Contribution from a Diocesan Fund)
Combined - List other Collection(s):

9a. Grant Information
Yes, we are requesting the following:
$ for Black American Evangelization programs.
Yes, we are requesting the following:
$ for Native American Evangelization programs.
No, we are not requesting a Grant.

9b. Request for Funding Details
Church/School/Group Name:
Pastor or Principal:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:
Phone:
Fax:
Please describe how the grant dollars will be used in your Diocese (1000 words or less):


Church/School/Group Name:
Pastor or Principal:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:
Phone:
Fax:
Please describe how the grant dollars will be used in your Diocese (1000 words or less):


Church/School/Group Name:
Pastor or Principal:
Street Address 1:
Street Address 2 (optional):
City:
State:
Zip Code:
Email Address:
Phone:
Fax:
Please describe how the grant dollars will be used in your Diocese (1000 words or less):

10. Promotional Materials

SINGLE Collection Arch/Dioceses - Promotional packets will be mailed to each parish. The parish names and addresses from the Official Catholic Directory will be used.

Arch/Dioceses with a COMBINED collection only, please check one of the following:

Send promotion packets to our parishes.

Do not send packets to the parishes.

11. Year 2012 Collection Envelopes for Parishes
Number of Parishes to receive Envelopes:

12. Signature of Ordinary
By Clicking here I certify that I the Ordinary for my Arch/Diocese has approved this request: