Coeur Dalene Tribe Request For Education Donation printable pdf download

Coeur Dalene Tribe Request For Education Donation

Coeur d’Alene Tribe | Request for Education Donation

Completed forms can be submitted to:

Coeur d’Alene Tribe

Office of the Chairman

Attention: Vernie Johnson, Executive Assistant

850 A Street

Plummer, ID 83851

Fax: (208) 686-8813

PART I: EDUCATION DONATION REQUEST

Donation requests must be received by September 30 of each year in order to be considered for funding in the

subsequent calendar year. Please attach any supporting documentation about the request to this form.

Organization:_______________________________________________________________________________

Contact Name:______________________________________________________________________________

Mailing Address:____________________________________________________________________________

City: ______________________ State & Zip Code: _________________ Phone Number: _________________

Amount Requested:______________________

Describe the purpose of the donation:

__________________________________________________________________________________________

Has the Coeur d’Alene Tribe and/or Coeur d’Alene Casino Resort Hotel and/or Circling Raven Golf Course

donated to your organization in the past 12 months?

YES / NO

If yes, how much was received from each entity, for what and when?

__________________________________________________________________________________________

NOTE: Receipt of funds in previous years does not guarantee additional funding.

The above is correct to the best of my knowledge, and if the donation is approved, the goods and/or funds will

be used solely and expressly for the purpose listed.

_________________________________________________________________________________________

Signature

Date

Coeur Dalene Tribe Request For Education Donation