Jumpstart Intake Form — CCMA

Project Jumpstart: Grant Activation

Name

First Name

Last Name

Email

Name of Campus Ministry Center

I.e. St. Paul's Catholic Center at The University of XYZ

Precise address where check should be mailed

Include an "Attn: John Smith" if helpful

Amount you have been approved to receive grant from CCMA to be used for Evangelical Catholic's coaching program:

I.e. $500, $1,000 etc.