PLEASE RETURN COMPLETED FORM TO: AGUSM 1445 N BOONVILLE AVE SPRINGFIELD MO 65802 AGUSMFINANCE@AG.ORG OR FAX: 417-863-7276

Spouse Stipend Renewal Form

Account Holder:

Department:

Account #:

❖ I verify that I am working in ministry:Full Time (40 hours per week) and do not have a full-time job.

Part Time (at least 20 hours per week).

❖ I am appointed through AGUSM:Yes

No

❖ I am

❖ I hold credentials with district/network.

Spouse Stipend Chart (Monthly Amounts)

Credentials Commissioned Non-Commissioned

Licensed/Ordained Full: $2000 Part: $1000 Full: $1000 Part: $500

Certified Full: $1500 Part: $750 Full: $750 Part: $375

Non-Credentialed Full: $500 Part: $250

Please complete and return the form by December 15th of each year or your stipend or the next year will be cancelled. We will not be sending reminders. The amount being requested must be included in your budget.

Signature : Date :

First & Last Name

If you wish to receive less than the approved amount, please list lower amount. $

Renewal Year:Spouse:

AGUSM Accounting Verification

Amount in budget: $ Update USMIA: Initials/Date: