Clergy

Application for Wellness Fund Assistance

The Fund for Clergy and Clergy Family Wellness was established in 2000 and provides assistance with medical expenses, counseling, and other un-reimbursable expenses for the insured cleric and immediate family members. There is a limit of $5,000 per family for each CAF fiscal year. (April 1- March 31) We also fund spiritual retreats ($1,500 maximum), counseling and other similar needs. Complete this application, then print it out and submit it to your diocesan bishop or pastoral care officer for approval before sending it to us.

Contact Information

First Name

Last Name

Street Address

City

State

Zip Code

Phone Number

Email Address:

Canonical Residence

Amount Requested:

Category of Need:

Medical / Dental / Psychological Evaluation / Treatment Prescription Drugs Vocational / Professional Evaluation & Assistance Spiritual Counseling / Retreat Expenses

Briefly describe specific situation:

What other funds have been used / are available to help meet this need?

Other information to assist in evaluating this application may be supplied below or on a separate page.

Clergy

Application for Wellness Fund Assistance

Contact Information

Category of Need:

Position: