2017 WORLD CHANGERS PROJECT REQUEST FORM
2017 WORLD CHANGERS PROJECT REQUEST FORM Please complete the entire form and return to
World Changers, 1 LifeWay Plaza, MSN 144, Nashville, TN 37234-0144 NEW PROJECTS SHOULD COMPLETE THE ENTIRE APPLICATION; RETURNING PROJECTS SHOULD COMPLETE PARTS 1-3 ONLY.
PROJECT CITY: PART 1: CONTACT INFORMATION INITIATOR INFORMATION NAME: ADDRESS: PHONE: (
CITY: )
-
STATE:
ZIP:
E-MAIL:
ASSOCIATIONAL INFORMATION NAME OF ASSOCIATION: DIRECTOR OF MISSIONS: ADDRESS: PHONE: (
CITY: )
-
STATE:
ZIP:
E-MAIL:
STATE LEADERSHIP INFORMATION STATE EXECUTIVE DIRECTOR: STATE DIRECTOR OF MISSIONS: ADDRESS: PHONE: (
CITY: )
-
STATE:
ZIP:
E-MAIL:
LOCAL HOUSING/FUNDING AGENCY INFORMATION AGENCY: CONTACT PERSON: PHONE: (
)
-
E-MAIL:
World Changers | 2017 PAGE 1
PART 2: PROJECT DETAILS PROJECT DATE PLEASE LIST THE SPECIFIC WEEK IN THE SUMMER OF 2017 THAT YOU ARE REQUESTING FOR YOUR PROJECT: (PROJECTS WILL LIKELY FALL BETWEEN JUNE 13 – JULY 29, 2017.)
PROJECT TYPE PLEASE CHOOSE FROM THE FOLLOWING LIST THE TYPE OF PROJECT YOU ARE REQUESTING: ALL YOUTH CONSTRUCTION
SENIOR HIGH CONSTRUCTION
COLLEGIATE CONSTRUCTION
COMMUNITY (MINISTRY BASED – ALL YOUTH) PLEASE CHOOSE FROM THE FOLLOWING LIST THE LENGTH OF PROJECT YOU ARE REQUESTING: 5-DAY
6-DAY
7-DAY
***All 5-DAY projects will start on MONDAY and end on SATURDAY. All 6-DAY projects will start on SATURDAY and end on FRIDAY. All 7-DAY projects will start on SATURDAY and end the following SATURDAY.
LODGING TYPICALLY, WORLD CHANGERS PROJECTS ARE LOCATED IN A SCHOOL OR CHURCH. HAVE YOU IDENTIFIED A POSSIBLE LODGING SITE FOR THE PARTICIPANTS? YES NO IF YES, PLEASE COMPLETE THE FOLLOWING: NAME: ADDRESS: PHONE: (
CITY: )
-
STATE:
ZIP:
E-MAIL:
CONTACT PERSON:
PART 3: APPROVAL AND SIGNATURES IT IS YOUR RESPONSIBILITY AS THE INITIATOR OF THE PROJECT TO SHARE THIS INFORMATION WITH YOUR STATE CONVENTION. PLEASE INITIAL ONCE YOU HAVE NOTIFIED THE STATE CONVENTION OF YOUR INTENT TO REQUEST A WORLD CHANGERS PROJECT IN YOUR COMMUNITY. (INITIALS) INITIATOR SIGNATURE: _______________________________________________________ DATE: ___________________________ ASSOCIATIONAL DIRECTOR OF MISSIONS SIGNATURE: ______________________________ DATE: ___________________________ PASTOR SIGNATURE (CHURCH BASED PROJECT ONLY): ______________________________ DATE: __________________________
World Changers | 2017 PAGE 2
PART 4: FUNDING THIS SECTION IS TO BE COMPLETED BY THE LOCAL HOUSING/FUNDING AGENCY. 1.
WHERE IS YOUR MONEY COMING FROM FOR THE BUILDING MATERIALS ON THE HOMES THAT YOU WILL SELECT?
2.
DO YOU HAVE ANY PRIVATE SECTOR MONEY?
YES
NO
IF SO, HOW MUCH?
DO YOU HAVE ANY MONEY THAT WILL BE USED OTHER THAN HUD MONEY, SUCH AS MAY’S DISCRETION, REGULAR BUDGET, ETC.? YES NO IF SO, HOW MUCH?
3.
ARE YOU AWARE OF THE HUD REGULATIONS FOR LEAD-BASED PAINT? YES NO HOW DO YOU PLAN ON PREPARING WORLD CHANGERS NEXT SUMMER IN REGARD TO THESE REGULATIONS?
IS IT UP TO YOU TO INTERPRET THESE REGULATIONS AND IMPLEMENT THE CHANGES FOR YOUR CITY?
YES
IF NOT YOU, WHO IS?
World Changers | 2017 PAGE 3
NO
PART 5: STATEMENT OF NEED THIS SECTION IS TO BE COMPLETED BY THE INITIATOR. 1.
DESCRIBE HOW A WORLD CHANGERS WORK PROJECT WOULD ENHANCE YOUR COMMUNITY AND THE CURRENT WORK OF YOUR CHURCH, ASSOCIATION, COMMUNITY OR STATE CONVENTION.
2.
DESCRIBE THE TYPE OF HOUSING NEEDS THAT EXIST IN YOUR COMMUNITY.
World Changers | 2017 PAGE 4
World Changers, 1 LifeWay Plaza, MSN 144, Nashville, TN 37234-0144 NEW PROJECTS SHOULD COMPLETE THE ENTIRE APPLICATION; RETURNING PROJECTS SHOULD COMPLETE PARTS 1-3 ONLY.
PROJECT CITY: PART 1: CONTACT INFORMATION INITIATOR INFORMATION NAME: ADDRESS: PHONE: (
CITY: )
-
STATE:
ZIP:
E-MAIL:
ASSOCIATIONAL INFORMATION NAME OF ASSOCIATION: DIRECTOR OF MISSIONS: ADDRESS: PHONE: (
CITY: )
-
STATE:
ZIP:
E-MAIL:
STATE LEADERSHIP INFORMATION STATE EXECUTIVE DIRECTOR: STATE DIRECTOR OF MISSIONS: ADDRESS: PHONE: (
CITY: )
-
STATE:
ZIP:
E-MAIL:
LOCAL HOUSING/FUNDING AGENCY INFORMATION AGENCY: CONTACT PERSON: PHONE: (
)
-
E-MAIL:
World Changers | 2017 PAGE 1
PART 2: PROJECT DETAILS PROJECT DATE PLEASE LIST THE SPECIFIC WEEK IN THE SUMMER OF 2017 THAT YOU ARE REQUESTING FOR YOUR PROJECT: (PROJECTS WILL LIKELY FALL BETWEEN JUNE 13 – JULY 29, 2017.)
PROJECT TYPE PLEASE CHOOSE FROM THE FOLLOWING LIST THE TYPE OF PROJECT YOU ARE REQUESTING: ALL YOUTH CONSTRUCTION
SENIOR HIGH CONSTRUCTION
COLLEGIATE CONSTRUCTION
COMMUNITY (MINISTRY BASED – ALL YOUTH) PLEASE CHOOSE FROM THE FOLLOWING LIST THE LENGTH OF PROJECT YOU ARE REQUESTING: 5-DAY
6-DAY
7-DAY
***All 5-DAY projects will start on MONDAY and end on SATURDAY. All 6-DAY projects will start on SATURDAY and end on FRIDAY. All 7-DAY projects will start on SATURDAY and end the following SATURDAY.
LODGING TYPICALLY, WORLD CHANGERS PROJECTS ARE LOCATED IN A SCHOOL OR CHURCH. HAVE YOU IDENTIFIED A POSSIBLE LODGING SITE FOR THE PARTICIPANTS? YES NO IF YES, PLEASE COMPLETE THE FOLLOWING: NAME: ADDRESS: PHONE: (
CITY: )
-
STATE:
ZIP:
E-MAIL:
CONTACT PERSON:
PART 3: APPROVAL AND SIGNATURES IT IS YOUR RESPONSIBILITY AS THE INITIATOR OF THE PROJECT TO SHARE THIS INFORMATION WITH YOUR STATE CONVENTION. PLEASE INITIAL ONCE YOU HAVE NOTIFIED THE STATE CONVENTION OF YOUR INTENT TO REQUEST A WORLD CHANGERS PROJECT IN YOUR COMMUNITY. (INITIALS) INITIATOR SIGNATURE: _______________________________________________________ DATE: ___________________________ ASSOCIATIONAL DIRECTOR OF MISSIONS SIGNATURE: ______________________________ DATE: ___________________________ PASTOR SIGNATURE (CHURCH BASED PROJECT ONLY): ______________________________ DATE: __________________________
World Changers | 2017 PAGE 2
PART 4: FUNDING THIS SECTION IS TO BE COMPLETED BY THE LOCAL HOUSING/FUNDING AGENCY. 1.
WHERE IS YOUR MONEY COMING FROM FOR THE BUILDING MATERIALS ON THE HOMES THAT YOU WILL SELECT?
2.
DO YOU HAVE ANY PRIVATE SECTOR MONEY?
YES
NO
IF SO, HOW MUCH?
DO YOU HAVE ANY MONEY THAT WILL BE USED OTHER THAN HUD MONEY, SUCH AS MAY’S DISCRETION, REGULAR BUDGET, ETC.? YES NO IF SO, HOW MUCH?
3.
ARE YOU AWARE OF THE HUD REGULATIONS FOR LEAD-BASED PAINT? YES NO HOW DO YOU PLAN ON PREPARING WORLD CHANGERS NEXT SUMMER IN REGARD TO THESE REGULATIONS?
IS IT UP TO YOU TO INTERPRET THESE REGULATIONS AND IMPLEMENT THE CHANGES FOR YOUR CITY?
YES
IF NOT YOU, WHO IS?
World Changers | 2017 PAGE 3
NO
PART 5: STATEMENT OF NEED THIS SECTION IS TO BE COMPLETED BY THE INITIATOR. 1.
DESCRIBE HOW A WORLD CHANGERS WORK PROJECT WOULD ENHANCE YOUR COMMUNITY AND THE CURRENT WORK OF YOUR CHURCH, ASSOCIATION, COMMUNITY OR STATE CONVENTION.
2.
DESCRIBE THE TYPE OF HOUSING NEEDS THAT EXIST IN YOUR COMMUNITY.
World Changers | 2017 PAGE 4
