Servant's Heart Interest Form

Getting To Know Your Ministry

Thank you for taking the time to fill out our Interest Form.
We look forward to getting to know your ministry.

When you have answered all of the questions, click the Submit button at the end. Once we have received your submitted Interest Form we will contact you within 30 days regarding potential next steps. If you have any questions please reach out to us by email to: Lindsey@pkservantsheart.org and copy Ellie@pkservantsheart.org or call (949)759-3456.

Project Name:

character limit: 100
Primary Organization Name:

character limit: 250
Contact Name:

Email Address:

Year Founded:

Organization Website:

character limit: 2000
Mission Statement:
The main purpose for which the organization exists.

character limit: 5000
Spiritual Component:
Describe the spiritual component of how your organization models God’s concern for the total well-being of persons and communities.

character limit: 1000
Impact Statement:
What is your organization aiming to accomplish?

character limit: 3000
Impact Goals:
What are your organization's goals?

character limit: 5000
Impact Progress:
What have you accomplished so far and what is next?

character limit: 3000
Who are the Clients Served?:

character limit: 500
Summarize Your 1-3 Year PLAN:
What have you accomplished so far and what is next?

character limit: 3000
What Nation is the Headquarters located?:

character limit: 250
List Your Organization's Strategic Partners:

character limit: 1500
Where is the Primary Program Area?:

character limit: 250
Geographic Areas Served?:

character limit: 5000
Does your organization teach Self Reliance?:
Describe what your organization provides that teaches self reliance and/or any training of a skill, trade or business that will create a livelihood or means of support/income:

character limit: 500
Describe any ministry plans to move toward Self Sustainability:

character limit: 3000
Total Paid Staff: Full Time (#)
List total number of paid full-time employees

Total Paid Staff: Part Time (#)
List total number of paid part-time employees

Comments on Staff: (optional)

character limit: 500
Total Volunteers (#):
List the total number of volunteers in your organization.
Comments on Volunteers: (optional)

character limit: 500
Projects:
Briefly describe up to 5 projects your ministry would like to pursue where funding is not currently available:

character limit: 3000
Financial Information
Fiscal Year End:
Month / Day - This is the 12-month period for which the organization plans the use of its funds. This period may be a calendar year but can be any 12-month period. A fiscal year accounting period should normally coincide with the natural operating cycle of the organization. If your organization files an IRS Form 990, it is required to define its accounting period on Line A at the top of the form.

character limit: 250
Program Service Revenue ($):
Revenues received by the organization while charging for the services for which it received tax-exemption. Examples include tuition received by schools, admissions received by an art museum, and patient payments for medical services at a hospital, as well as government contracts.

Last Years Financials:
You may also attach a supportive document by selecting the Choose File button below.

character limit: 3000
Current Year Budget:
You may upload your attachment by selecting the Choose File button below.

character limit: 3000
What percentage % of your Annual Budget is covered by donations from Board Members?:
List the percentage %:

List the dollar amount in USD $:

Administration Expenses:
The necessary costs to maintain the organization's daily operations and management. For example, costs of board of directors' meetings, general legal services, accounting, insurance, office management, auditing, human resources, and other centralized services.

character limit: 250
What percent of your budget is spent on Administration?
List the percentage %:

List the dollar amount in USD $:

What are your total Fundraising expenses?:
This is the total expenses incurred in any activities that involve soliciting contributions, gifts, grants, etc.

character limit: 250
What percent of your budget is spent on fund development and communicating with donors?
List the percentage %:

List the dollar amount in USD $:

What are your total Program expenses?:
This is the amount of fees and other monies owed by the organization to outside sources directly related to carry out your organizations mission and for items and services rendered.

character limit: 250