First Name:
Last Name:
Church Name:
Church Address:
City:
State:
Zip:
Email Address:
Primary Phone
ex. xxx-xxx-xxxx:
Cell Phone
ex. xxx-xxx-xxxx:
What best describes you?:
Student Ministry size (high school):
Student Ministry size (middle school):

MINIMUM REQUIREMENTS FOR PROJECT 434 GRANT

Please read through the following standards and respond appropriately.  Saying 'no' or 'maybe' may not disqualify you from participation but may need further clarification.  You will be contacted by SRT Staff shortly following the completion of this survey.
REQUIRED - If I approve of the Project 434 materials, I will take my group through this program by March 31, 2010. Otherwise, I will return all materials within 30 days after receiving them if I decide not to use this program:
Yes No
REQUIRED - I will have a total of at least 25 students and/or parents combined in attendance:
Yes No Maybe
REQUIRED - I will fill out a short follow-up survey upon the completion of this program:
Yes No
OPTIONAL - I will ask the lead pastor to promote this program and to encourage parents to get involved:
Yes No N/A
OPTIONAL - I will reach out to the community and invite friends and other guests:
Yes No
Please explain any 'no's' or 'maybe's' in the optional or required fields. You may still qualify for this grant:
END OF SIGN-UP FORM.  PLEASE CLICK SUBMIT BELOW.