Application Deadline is March 31, 2019
2019 Lodge 43 Community Needs Grant Application for Financial Assistance
Name of Organization
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
Number of Employees: Number of Volunteers:
Other Sources of Financial Support (e.g. United Way,
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
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