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Committee | Grant Form
Region
Grant Form
Complete
and attach this form to each application. Download and fill-out the form
in PDF format:
Southwest Region Grant Application
Chapter President:
___________________________________________________________
Date: ______________
Telephone:
______________________________ Fax: ______________________
e-mail: _____________________
Mailing Address:
________________________________________________________________________________
Type of Grant
Being Applied For: (Check One) ______Project Grant
______Extend A Helping Hand Grant
Amount Requested:
$_____________
Name of Proposed
Project/Program: _________________________________________________________________
Application
must be signed by two Chapter officers:
Signature_______________________________________
Chapter Position__________________________________
Signature_______________________________________
Chapter Position__________________________________
| TO BE
COMPLETED BY SOUTHWEST REGION REPRESENTATIVE
Received
by: _________________________________________________________________
Date:
______________
Grant
Awarded? ___________ Amount: $___________________
Date
of Decision: ______________________
Grant
Committee Chair Signature: ________________________________________________
Date:
______________
Region
Treasurer Signature: ___________________________________________________
Date:
______________
Region
Manager Signature: _______________________________________________
Date:
______________
Check
sent by: ___________________________________ Date Sent: _____________
Check
Number: ____________
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