Application for Assistance
The Executive Lions of Vallejo desire to make funds available to non-profits that meet our priorities. Our priorities include:
• Eye care /vision
• Elderly and the youth
• Educational, recreational, and therapeutic activities
• Vallejo residents
If you desire to apply for financial assistance please provide the information below:
Name of Contact and Contact Information:
Name of Organization
Federal Tax ID
CA Franchise Tax Entity #
Contact Person & Position
Provide the Mission of your organization.
DESCRIPTION OF PROJECT / ACTIVITY
Provide a description of the project / activity for which you are requesting funds. Indicate clearly which of the above priorities (eye and vision care, elderly, youth, recreation, education, therapeutic) this project meets. Indicate when and where the activity will take place.
Describe who will benefit and how many persons will be served.
AUTHORIZATION & SIGNATURE
I hereby declare that 1) I am authorized to act on behalf of the agency submitting this request, 2) my organization hereby indemnifies and holds harmless the Executive Lions for any action regarding this application and the project / activity for which the organization is requesting funds.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service