Requestor Information

Information about the Person Submitting This Request

Name *

First Last

Address

Email *

Request Information

Information about the Person or persons Concerned

Name of the Person To Be Prayed For *

First Last

Relationship To Requestor Please Specify: Examples - Self, Family member, Coworker, Friend/Neighbor, etc *

Is The Person *
A Member of CUMC A Non Member who Attends Regularly Neither

Specifics of the Prayer Request

Topic of Request *
Addiction and Recovery Cancer Children/Youth Depression & Mental Health Family & Relationships Finances/Employment Grief Health & Healing Hospice/End of Life Spiritual Guidance Surgery

Please Have A Pastor Call Me *
Yes No

This Request is Confidential (Pastors Only) *
Yes No