Coins For Children Application Form
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1Coins for Children Application
Lodge Name: _________________
Amount Requested: $ ________
Lodge Number: ________________
Lodge Secretary Information:
For Office Use Only:
Name: ____________________
Date Received ______________
Address: __________________
Approved? _________________
City: _____________________
Date Closed ________________
Zip Code: _________________
Amount Approved ___________
Phone: ____________________
Publicity? __________________
E-Mail ____________________
Chmn. Sig. _________________
Proposed Request (Please explain how the funds will be used):
Receiving Organization: _______________________________________
Purpose: __________________________________________________
_________________________________________________________
_________________________________________________________
Fund Raising Activity: (No activity listed=application will be denied)
Date: ___________________
Activity: ___________________________________________________
Guidelines:
•
The request must be for a child or children under the age of 18
residing in the lodge's district.
•
Priority will be given where critical need is established.
•
The lodge must provide a copy of both the front and back of the
check given to the charity or person.
•
Donated funds are to be from lodge fundraising activities and NOT
directly from the lodge treasury or member assessment.
•
If approved, a Grand lodge check will be drawn to the same payee as
the lodge check and will be sent to the lodge for presentation by
lodge members).
•
Local publicity must be provided to the Coins for Children
Committee.
•
Scholastic scholarships, the Masonic Academic Bowl, the Student
Assistance Program, Masonic youth organizations, and expense
reimbursement to a Lodge for a sponsored activity are not eligible.
•
Sponsorship of regularly funded activities, such as Boy and Girl
Scout troops, Boys or Girls State, and athletic teams are
generally excluded. Identical repeats strongly discouraged.
Return a copy of this proposal,
Ben Grisham, Grand Secretary
with a photocopy of the lodge
2866 Via Verde
check, to:
Springfield, IL 62703
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