Tilbury & District Kinsmen Club
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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:_______________________________________ _______________________________________________________________________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
If funds are being used for an event,
can you give a detailed description:
Have you requested money from The Tilbury Kinsmen Club: No: ____ Yes: ____ If yes- Give reason: _________________________________________________________________________ Which Kinsmen event did you last attend?(This has no bearing on our donation.)
____________________________________________________________________
Email your request to: Thank you for taking interest in The Tilbury Kinsmen Club. The form will be forwarded to the membership for consideration. Tilbury & District Kinsmen Club
Box 1810 Tilbury Ontaio N0P 2L0
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