Mission Pre-born | Grant Application

Directors Name*

First Last

Name of Center:*

Directors Phone #*

Directors Cell #

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Center Phone #

Federal Tax-ID #*

List Board Members - Position - Length of Service - Church

Number of Employees

Number of Volunteer Counselors

Annual Ministry Budget

# of Pregnancy Tests Given Last Year

# of Ultrasounds Given Last Year

# of Abortion Minded or Vulnerable Clients Seen Last Year

# of Gospel Presentations Given Last Year

# of Clients Who Made a Commitment to Christ Last Year

Hours of Operation

We recommend using doppler on abortion vulnerable clients, do you agree?*

Are you applying for an ultrasound machine or cash towards ultrasound machine?

Phone

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Grant Application