Name of
organization or
person requesting
funds:________________________________________________
Contact person:
_______________________________________________________
Your Name:
_________________________________________________________
Phone #: ________________________ Fax:
_______________________________
Address: _______________________________
Postal code:___________________
Website:
________________________________ Charity
number:_______________
How much are you requesting:
$____________________
What are the funds being used for ( be
specific ) :
_____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Do you have a budget or financial
statement for this project: YES or NO If yes, please
supply a copy
If no, reason:
____________________________________________________________________________
____________________________________________________________________________
Have you requested funding from any
other organizations: No: _____or Yes:____
If yes
-Who:__________________________________________________________________
Due you have financial aid from other
sources: No:_____ or Yes:_____
If yes – Who:
____________________________________________________________________________
How much: $___________________________
Can you explain why you feel this
request should be
funded:_______________________________________
___________________________________________________________________________
