Lodge 43 Community Needs Grant Application 2019

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Application Deadline is March 31, 2019

2019 Lodge 43 Community Needs Grant Application for Financial Assistance

Name of Organization

Mailing Address

Primary

Contact Phone

Number

E-Mail Address

Web Site

Mission and Brief History of Organization:

Is this your first grant application to our Club ? Yes No

Is the organization a 501C3 status? Yes No Tax

ID#

Number of Employees: Number of Volunteers:

Other Sources of Financial Support (e.g. United Way,

etc.)

Amount Requested: $

Intended Use of Funds: (Please include a description of the number, ages and character of the people who will most benefit from this assistance)

Other Supporting Information:

The following items should accompany your proposal:

1. A cover letter using your organization’s stationery.

2. A roster of your Board of Directors and Officers.

3. A current budget for the organization.

I AFFIRM THAT ALL INFORMATION GIVEN ON THIS APPLICATION IS CORRECT I AFFIRM THAT ALL INFORMATION GIVEN ON THIS APPLICATION IS CORRECT AND ANY FUNDS RECEIVED FROM LODGE 43 WILL BE USED FOR THE STATED PURPOSE

Signature

Title

Date

Please send the completed request to:

Secretary, Lodge 43 216 West Chestnut Street

Lancaster, PA 17603 All applications must be received by March 31, 2019

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