Kiawah-Seabrook Exchange Club

GRANT REQUEST FORM

ORGANIZATION NAME:

ADDRESS:

CITY:

STATE:

ZIP CODE:

TELEPHONE NUMBER:

FAX NUMBER:

NAME OF EXCHANGE CLUB SPONSOR:

• ESTIMATED NUMBER OF CHILDREN / ADULTS SERVED BY THIS  PROJECT
  

SUMMARY OF THE NEED FOR THIS GRANT APPLICATION

• AMOUNT OF MONEY REQUESTED FOR THIS PROJECT
  

• EXPLANATION OF HOW THE MONEY WILL BE SPENT
  

• PAST GRANTS FROM OUR ORGANIZATION?
  

         (INCL: AMOUNT AND YEAR)

• IF YES, HOW WERE THESE PAST FUNDS UTILIZED AND WHAT WERE THE RESULTS ACHIEVED?
  

IF APPLICABLE: FEDERAL TAX ID NUMBER

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Please include here any additional explanatory documentation about this grant request that will help the Committee reach a decision.  It should include your Mission Statement and more information about your program and how it serves the community. It might include a complete budget showing how this proposal fits into your budget and will help further your objectives  Add other documentation if you believe it will strengthen your request.

Information not possible to be included above should be sent either:

by email to:                                   vivrog@bellsouth.net  (Roger Steel)

by regular mail to:

KAIWAH-SEABROOK EXCHANGE CLUB

Box: PMB-J

130 Gardener's Circle

Johns Island, SC 29455

PRIMARY CONTACT:

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ADDITIONAL DOCUMENTATION

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DATE SUBMITTED