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Funding Request Form



Optimist International
Friend of Youth




Organization name:

Contact Person:
Address:
City/State/Zip:
Phone:

Short Description of Funding Request:

Approximate Number, Age and Demographics of Youth to be Served by Funds Requested:

Is there currently other funding available for this project (Government funding or other matching funds)?

If so, please describe:

Are there other programs available, similar to the one you are requesting funds for?
If so, please describe:

ORGANIZATIONAL INFORMATION


Please list your local board of directors or other governing body:

NAME         Title
NAME         Title
NAME         Title
NAME         Title
NAME         Title

Does your organization have state, national or corporate affiliations?

If so, please describe:

What are the main sources of funding for your organization?

Any other comments you wish to make: