PARK RIDGE LIONS CLUB
Organization Request for Grant

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The Park Ridge Lions Foundation will consider requests to fund projects or programs to eligible charitable or civic organizations in the Park Ridge Community. Please complete the attached application and return to the Park Ridge Lions. Application deadline is December 1 in order to be considered for a grant in the following calendar year.

Priority for funding will be given to organizations or projects located in the Park Ridge community, and to those with Park Ridge Lions participation. Special consideration is granted for organizations, projects and programs that assist people with hearing, vision and other disability related conditions.

Please print out this application and return to:

Park Ridge Lions Club
P.O. Box 200
Park Ridge, Illinois 60068

Organization name:_______________________________________________________

Address:_______________________________________________________________

City:_______________________________ State:_______________ Zip:____________

Telephone:___________________________ Fax:______________________________

Name of organization contact:_______________________________________________

Description of need:_______________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Amount of grant request:______________________ Preferred payment date:__________

Circle One:
Yes No Organization is an IRS approved, 501 C-3, charitable entity
Yes No Does the organization maintain policies against discrimination?
Yes No Is the organization a grant-making entity?
Yes No Is this a sponsorship function involving the purchase of tickets or advertisements?
Yes No Are members of the Park Ridge Lions involved with the organization?
Yes No Will residents of the Park Ridge Community be impacted through this grant?
Yes No Is this grant targeted to serve people with hearing, vision or other disabling conditions?
Yes No Is the organization supported by the United Way or other federated fund-raising entity?

Organization budget:__________________________ # of paid staff:_____________________
Use additional pages as necessary. Return with brochures, newsletters, articles and other support materials.

Signature:__________________________________ Date:____________________

Approved grant recipients must agree to terms and conditions set forth by the Park Ridge Lions Club and Foundation.