Application Deadline is March 31, 2020
2020 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, 2020