Church Partnership Sign-Up/Renewal

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Church Partnership Registration/Annual Renewal

Type of Registration*

New Church Partner Annual Renewal

We are committed to this Hephzibah62:4 Partnership level for upcoming year (choose one)*

1. Momentum Catalyst Church: Building a culture of care and support 2. Momentum Builder Church: Ongoing, organized church-based ministry or financial partnership 3. Momentum Multiplier Church: Actively multiplying your ministry model

*See detailed partnership descriptions at hephzibah.org/partner

Name of Wesleyan Church*

If you haven't done so previously, please upload your church's logo (preferably high quality, transparent background), for use in our promotions

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You may also e-mail logo file to info@hephzibah.org

Do you need to update your street or mailing address? *

Yes No

Church Street Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Is your mailing address the same as your street address?*

Yes No

Church Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Wesleyan District*

*Visit www.wesleyan.org/about/districts to determine your district affiliation

Name of church Point Person for this partnership*

First Name*

Last Name*

Point Person's role in the church*

Volunteer Lay Leader Church Staff Member Associate Pastor Lead Pastor

Other: Other Value

Check all that apply

Point Person's e-mail address*

Confirm Point Person's e-mail address *

Point Person's phone number*

Would you like to add a second Point Person for this partnership?*

Yes No

Name of second Point Person*

First Name*

Last Name*

Second Point Person's role in the church*

Volunteer Lay Leader Church Staff Member Associate Pastor Lead Pastor

Other: Other Value

Check all that apply

Second Point Person's e-mail address *

Confirm Second Point Person's e-mail address *

Second Point Person's phone number *

Name of Lead Pastor (if not already listed in contacts)

Our Lead Pastor is aware of and in agreement with our church's Hephzibah62:4 Partnership.*

Yes

We affirm our Hephzibah62:4 Church Partnership commitment for the coming year, as outlined at hephzibah.org/partner*

Yes

Signature*

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Tell us about your current church culture and ministries

Please indicate the focus of your Hephzibah62:4-related awareness activities from the past year (check all that apply)*

Sanctity of Human Life Sunday (January) National Slavery & Human Trafficking Prevention Month (January) Poverty Awareness Month (January) National Developmental Disabilities Month (March) National Autism Awareness Month (April) National Foster Care Month (May) Orphan Sunday (November) Stand Sunday (November) National Adoption Awareness Month (November) Just getting started

Other: Other Value

Please specify

Our church is engaged in transforming the lives of vulnerable children through commitment/s in these areas (check all that apply)*

Trauma-Informed Care Sanctity of Human Life Special Needs Ministry Anti-Trafficking Family Preservation (includes poverty prevention and alleviation) Foster Care Adoption Ongoing commitment with a Hephzibah Legacy Partner. See hephzibah.org/grant-opportunities/legacy-grant/ Regular financial support for Hephzibah62:4

Other: Other Value

Please specify

Which best describes your church's Trauma-Informed Care commitment? (check all that apply)*

We have used Trauma Free World's training to equip our team Our leaders have participated in trauma-informed care training Our volunteers have participated in trauma-informed care training Trauma-informed care is embedded in our church's discipleship and outreach culture

Other: Other Value

Please specify

Which best describes your church's Sanctity of Human Life commitment? (check all that apply)*

We provide regular opportunities to increase our congregation's awareness of the needs in this area We provide regular opportunities for hands-on engagement We have an ongoing partnership with a local Sanctity of Life-related organization We operate a church-sponsored Sanctity of Human Life ministry A Sanctity of Human Life focus is embedded into our church's culture

Other: Other Value

Please specify

Which best describes your church's Special Needs Ministry commitment? (check all that apply)*

We provide regular opportunities to increase our congregation's awareness of the needs in this area We have an ongoing partnership with an organization committed to Special Needs Ministry We operate a church-sponsored ministry for children/youth with special needs We offer support for parents and families whose families are impacted by special needs Ministry to individuals and families impacted by special needs is embedded into our church's culture

Other: Other Value

Please specify

Which best describes your church's Anti-Trafficking commitment? (check all that apply)*

We provide regular opportunities to increase our congregation's awareness of the needs in this area We provide regular opportunities for hands-on engagement in our local community We have an ongoing partnership with a local Anti-Trafficking organization We operate a church-sponsored local Anti-Trafficking ministry An Anti-Trafficking focus is embedded into our church's culture

Other: Other Value

Please specify

Which best describes your church's Family Preservation commitment? (check all that apply)*

We provide regular opportunities to increase our congregation's awareness of the needs in this area (includes poverty prevention and alleviation) We provide regular opportunities for hands-on engagement with vulnerable children and families in our community We have an ongoing partnership with a local organization committed to Family Preservation We operate a church-sponsored Family Preservation ministry A Family Preservation focus is embedded into our church's culture

Other: Other Value

Please specify

Which best describes your church's Foster Care commitment? (check all that apply)*

We provide regular opportunities to increase our congregation's awareness of the needs in this area We provide regular opportunities for hands-on support of foster children and families We have an ongoing partnership with a local organization committed to meeting the needs in Foster Care We operate a church-sponsored Foster Care ministry We recruit for needed roles in the foster care system (mentors, respite providers, support volunteers, Court Appointed Special Advocates, foster and adoptive parents) A Foster Care focus is embedded into our church's culture

Other: Other Value

Please specify

Which best describes your church's Adoption commitment? (check all that apply)*

We provide regular opportunities to increase our congregation's awareness of the needs in this area We promote the Hephzibah62:4 Adoption Fund We provide regular opportunities for hands-on support of adoptive families We have an ongoing partnership with a local organization committed to meeting the needs in this area We operate a church-sponsored Adoption ministry We recruit Adoptive parents An Adoption focus is embedded into our church's culture

Other: Other Value

Please specify

Please indicate which Hephzibah Legacy Partner your church is committed to support/serve.

Mosaic Church of Detroit, MI Core Church/CityBridge, NC The Connection Church, OH

Please describe your financial commitment to Hephzibah62:4 for the coming year:*

Monthly commitment Annual commitment Special fund raiser/s

Other: Other Value

Please list any related church ministries or organizational partners.

NEW PARTNERS, please describe your church's involvement in the areas indicated above.*

RENEWING PARTNERS, please provide any applicable ministry updates from the past year.*

Caring for vulnerable children and families is part of our church's holistic discipleship plan.*

Yes No Unsure

HELP US INSPIRE OTHERS! Briefly describe at least one story or testimony that you are willing to share in Hephzibah62:4 or The Wesleyan Church's communications, that reflects our mission of transforming the lives of vulnerable children. How did God use your church ministry to impact those serving and/or those being served?*

*If needed, we will contact you for further details when we're able to use your story/testimony

How has your Hephzibah62:4 partnership been a blessing to your church and ministry this past year?

*What has surprised, encouraged, or challenged you?

We are interested in the following Hephzibah62:4 benefits for the coming year (check all that apply) *

Coaching Call (see scheduling link at hephzibah.org/partner) Hephzibah62:4 Prayer & Mobilization Guide - PDF & Print Versions Adoption Fund Post-Adoption Fund Parent Support Grant Christian Alliance for Orphans' Summit Grants (Partner-only, one time/person benefit, next opportunity September 18-20, 2024, Nashville) Disability & The Church Conference (Partner-only, one time/person benefit, next opportunity May 1-3, 2024, Orlando) Trauma Free World training (3-hr training is Partner-only benefit) On-demand ministry trainings (ask which course/s are right for you) Project62:4 Grants Hephzibah62:4 Church Plant Grant (scroll down to see ongoing requirements to qualify for 2nd & 3rd year grants at hephzibah.org/church-plant-grant) Hephzibah62:4 Church Ministry Grant (NEW opportunity for established churches! Application deadline is April 30) I would like to request or discuss a custom benefit opportunity

Other: Other Value

*Visit hephzibah.org/partner/#partner-benefits-chart to review all current partner benefit details

Is there anything else you'd like to suggest or share with us?

Your feedback and ideas are important to us

How can we be praying for you?

Our team prays for each request received