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Special Gifts Grants Request Form |
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| Request from District
______________________ Zone _________________ Society
________________ Contact Person __________________________ Phone ________________ E-Mail _________________ Address ____________________________________________________________________________ |
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| Signature of
President/Chairman _______________________________________ Date
______________
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| A. Please define the
need for the grant. 1. What is the need or circumstance? 2. Is this project one time, start-up, or ongoing? 3. Is there additional funding from other sources?
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| B.
Define the recipeint(s) in relation to the need. 1. List the name(s) of the recipient(s). 2. Is the recipient an individual, a group, or an agency? 3. Explain how the grant will cover the need - totally or partially?
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| C.
Follow-up -- How will the contact person follow-up to assure the need
has been met?
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| D.
Other -- Please add any other information pertaining to the
request that you feel is important. Continue your comments on a
separate sheet of paper if necessary.
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| ------------------------------------------------------------------------------------------------------------------------------------------------ Date approved by the Committee ______________________ Signature of a Committee member ________________________________________________________ |