Gary B. Burt Advised Endowment Fund Application

To assist local Lions club in collecting eye glasses for distribution on mission trips.
To provide funds to local Lions club to provide student scholarships to special camps and activities to qualified persons.
To assist local Lions clubs in providing persons with student scholarships to Indiana State Police Lions Law Camp.
To assist local Lions clubs in providing assistance to personas with medical needs.

Needs to be requested by a Lions club in good standing. Not more than 1 grant per Lions year.

"*" indicates required fields

Name of Club Making Request*

District*

Project Title*

Amount Requested*

Club Officer*

First Last

Title*

Address*

Street Address City State ZIP Code

Email*

Phone*

Federal EIN #*

Briefly Describe the Project Including Budget*

Signature*

Date of Application*

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