Grant Application Form

Middle Districts Lions Club ‘Community Needs & Grants’ committee will consider grant applications over three four-month terms closing at the end of February, June & November.

For grants under $1,000 they will be reviewed and accepted/declined monthly from February up to and including November.

Lions favour applications (although not exclusively) focusing on Childhood Cancer, Diabetes, Disaster Relief, Environment, Humanitarian, Hunger, Vision and Youth.

If you would prefer a hard copy of this form, you can download it here: Grant Application Form & Criteria.

Full Name/ Organisation*

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Address*

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Phone Number*

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Email*

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Account Number*

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Amount Sought*

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Date required by*

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Total Cost of project/proposal*

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What area is this proposal for?*

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Grant Purpose*

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Please describe the purpose and objectives of your proposal/project:*

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Cost Breakdown*

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Have you applied for Grants/Assistance from other organisations for this same project/purpose?*

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The information provided in this application is true and correct to the best of my knowledge: (If an Organisation I/we confirm I/we have
authority to sign on behalf)

Signed*

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