CAPITAL ASSISTANCE FUND: PASTORAL CHARGE/CONGREGATION CA 2A
APPLICATION FORM FOR CAPITAL ASSISTANCE FUND
PASTORAL CHARGE/CONGREGATION
• Read attached Instructions and Accessibility Complete four copies:
Guidelines. 1. Local records
• Print or type. 2. Presbytery and/or
3. Conference
4. Congregational, Educational,
and Community Ministries
Application on behalf of: For:
Loan Grant
Church New Construction
Pastoral Charge Manse Renovation
Other (specify below) Addition
Specify
Congregation
Number and Street Address
City or Town Presbytery
Province Postal Code Conference
1. Project Description
(a) On a separate page(s), give a brief description of the capital project and its intended accomplishment.
Include:
(i) How the project complies with Congregational, Educational, and Community Ministries Capital
Assistance policy.
(ii) A statement of the mission design, which gives the purpose and goals of the project, the strategy plan,
and how this changes the current plan of operation.
(b) Attach a sketch or schematic drawings to show the floor plan, interior and exterior elevations, accessibility
for people with disabilities, and plot plan showing parking lot (if applicable).
(c) Attach the previous year’s Financial Statement of the applicant (pastoral charge or congregation), including
the Balance Sheet of Assets and Liabilities and the current Operating Statement of Income and
Expenditures. Specify the annual financial assistance provided by presbytery and for Conference. Also
include a current quarterly financial statement.
(d) Projected starting date of capital project:
(e) Projected completion date of capital project:
Financial Resources Handbook Page 1 CECM – August 2007
CAPITAL ASSISTANCE FUND: PASTORAL CHARGE/CONGREGATION CA 2A
2. Pastoral Charge Information (where applicable)
Charge Statistics (Present Calendar Year) Name of Congregation
TOTAL
A No. Households under Pastoral Care
B No. Contributing Households
C No. Resident Members
D Average Attendance at Worship
E Date of Last Every-Family Visitation
F Funds held in Trust by Applying Purpose
Congregation/Pastoral Charge $
G Give the figures for the pastoral charge or congregation making the application:
Amount raised previous year for:
1. Local $ 4. Per Household under Pastoral Care (G3/A) $
2. Mission & Service $ 5. Per Contributing Household (G3/B) $
3. All Purposes $ 6. Debt Retirement and Other $
3. Title Information
Title in Name of
Lot Size Registered at
4. Present Facilities (complete appropriate section (a) or (b))
(a) Church
Construction: Brick or Stone Frame Other (specify)
Parking Lot: Yes No
Sanctuary: Size Seating Capacity
Hall: Size Seating Capacity
Washroom(s): Yes No
Kitchen: Yes No
Educational Facilities (specify):
Midweek Use of Church Building:
Group Size Group Size
(b) Manse
Address/Location:
Construction: Total Floor Space: No. of Rooms:
Date of Construction: Present Valuation: $ Heating System:
Mortgage: Balance $ Balance of Amortization Period
Interest Rate Yearly Payment $
Financial Resources Handbook Page 2 CECM – August 2007
CAPITAL ASSISTANCE FUND: PASTORAL CHARGE/CONGREGATION CA 2A
5. Financial Plan for Project
(a) Cost $
(b) Resources
(i) Cash on hand $
(ii) Pledges payable before starting date of capital project $
(iii) Volunteer labour, donated materials $
(iv) Sale of property (specify) $
(v) Other (specify $
(vi) Local borrowing (specify) $
(vii) Congregational, Educational, and Community Ministries $ $
Loan Request $ ______________________
Grant Request $ ______________________
6. Ability to Repay (refer to Loan Repayment Schedule)
Pledges payable after date of construction/renovation/purchase: $
Repayment period required: years. Specify annual payments: $
Have you had a loan from the Capital Assistance Fund previously? Yes No
7. Repayment Notices Sent to
Name
Number and Street City Province
Postal Code Telephone
8. Cheque Made Payable to
Name of Pastoral Charge or Congregation
9. Trustees*
Full Name Occupation Address in Full
Full Name Occupation Address in Full
Full Name Occupation Address in Full
Full Name Occupation Address in Full
Full Name Occupation Address in Full
Full Name Occupation Address in Full
*If more space is needed, please attach on separate sheet(s).
Financial Resources Handbook Page 3 CECM – August 2007
CAPITAL ASSISTANCE FUND: PASTORAL CHARGE/CONGREGATION CA 2A
10. Action of Pastoral Charge/Congregation
At the meeting of
it was moved by and seconded by
and carried, that the Trustees of
be authorized and directed to make application to Congregational, Educational, and Community Ministries for a loan
of $
for a year term and a grant of $ and to make application to presbytery for its
consent to this, to sign the Agreement to Repay the loan approved by the Congregational, Educational, and
Community Ministries, Capital Assistance Fund for pastoral charge/congregation. The extenuating circumstance(s)
for the grant request are
Date of Action Signature
Office Held
11. Action of Presbytery or Committee of Conference
The foregoing application was duly considered at a meeting of the presbytery of
held on , 20 at and a loan totalling $
for a term of years and a grant of $ were approved by presbytery at such meeting.
(a) Presbytery declares that this project is in accordance with the Congregational, Educational, and
Community Ministries Capital Assistance policy. It is understood that approval of any grant being
requested is in principle only, subject to availability of funds.
(b) The Property Committee of presbytery has approved the schematic drawings, which meet The United
Church of Canada Accessibility guidelines.
(c) In approving this request, presbytery is in agreement that the project being undertaken is sound, valid, and
necessary for future ministry in this location. Presbytery will continue its function of the oversight of this
project.
(d) Presbytery also declares that the applicant, in its considered opinion, will be able to repay the loan
requested in the term approved by presbytery.
(e) Presbytery explicitly agrees with Congregational, Educational, and Community Ministries that it will not
grant consent to the above selling, mortgaging, leasing, or in any way encumbering its property or to
increasing its debt load for capital purposes while this loan or any part of it is unpaid except as is
expressly agreed in writing by Congregational, Educational, and Community Ministries.
Date Secretary of Presbytery
12. Conference Action*
This application has been reviewed and meets the Congregational, Educational, and Community Ministries
Capital Assistance policy. The recommendation for positive decision is:
Date Conference Officer
Position
*If more space is needed, please attach on separate sheet(s).
Financial Resources Handbook Page 4 CECM – August 2007