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St. Dymphna Grant Application

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  I, (insert name below), Pastor, am requesting a $500 St. Dymphna Grant on behalf of (insert parish name and city below) from the Apostolate for Persons with Disabilities - Diocese of Madison. This grant will be used for Mental Health Ministry in our parish to support those who are impacted directly or indirectly by mental illness in the development of their faith lives and /or involvement in our parish community.
  
  Pastor REQUIRED Please fill out this field. Please enter valid data.
  
  Parish REQUIRED Please fill out this field. Please enter valid data.
  
  Parish Town/City REQUIRED Please fill out this field. Please enter valid data.
  
  Information about Mental Health Advocate
  
  I have identified a Mental Health Advocate at my parish who will help with coordination of the Mental Health Ministry and will be in communication with the Apostolate for Person's with Disabilities. REQUIRED Yes Please fill out this field.
  
  Name of Mental Health Advocate REQUIRED Please fill out this field. Please enter valid data.
  
  Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  Pastor's Approval
  
  Pastor's Digital Signature REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter valid data.
  
  Pastor's Email REQUIRED Please fill out this field. Please enter valid data.
  
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