Request Assistance

APPLICATION FOR ASSISTANCE FROM THE KEVIN PATTERSON FUND
Please answer each question completely.

Parent Name

First Name

Last Name

List Student Name(s) and Age(s)

List Student(s) Date of Birth

Address / City / State / Zip

Cell Phone

Work Phone

Church Affiliation

Describe Current Financial Hardship

Amount Requested

Enter $ amount:

Is the request for an OFLC event, student retreat or mission trip?

Date

Name of OFLC Member/Staff who referred you to the KP Fund

Comments