TAP FAITH FINANCIAL AID REQUEST

NO FUNDING AVAILABLE AT THIS TIME

WEBSITE; http://tapfaithpartnerships.org

A grant is a one time disbursement which does not have to be paid back.

A revolving loan may incorporate one or more disbursements, which must be paid back, to the trust, ministry or helping hand which disbursed it. When paid back, the revolving loan, will be reused to help others.

(Check one) GRANT_____ REVOLVING LOAN _____

APPLIANT INFORMATION

Last Name: ______________________________ First Name: _______________ MI: _____

Driver’s License or ID Number: ____________________ State: _____

Housing provider or helping hand __________________________________________

Street Address: ________________________________________________________________________

City: _______________________________________ State: _____ Zip: _________

Telephone #: _____________________ or Contact person ____________________ phone # ________________


REVOLVING LOAN AGREEMENT


My signature below constitutes my request and if successful , receipt of (circle one) a GRANT / REVOLVING LOAN in

the amount of $ ________________, disbursed at the rate of $ _______________, (circle one) weekly/monthly, to be

used for ___________________ assistance.


I, (print) _________________________________ agree to repay the revolving loan at the rate of $ _______________ per week/month (circle one) until

 such time time as the entire amount is repaid, beginning on ____________ _______, 2012 and ending on ______________ _____, 2012. I understand

 that failure to honor this agreement may result in discredidation and or early termination of the assistance provided.

APPLICANT'S SIGNATURE

Signature: ____________________________________________________ Date: ___________________

FOR TAP FAITH , ENTITY AND OR INDIVIDUAL HELPING HAND RECORDS:

DISBURSEMENT DATE ___________________ DISBURSEMENT AMOUNT_______________________

DISBURSING ENTITY OR INDIVIDUAL (print) __________________________________________________

SIGNATURE OF DISBURSING ENTITY OR INDIVIDUAL __________________________________________________