Part 1

Indicate Requested Action(Required)
Note: A 2% fee for each withdrawal total will be retained by the Foundation.

Part 2

Note: All applications MUST have this number to be considered.

Part 3

Is the project for which you have solicited the dedicated grant a Civic or Public Project, which will not result in a personal benefit or compensation to a member of the organization making this application?(Required)

The applicant, in making this application, also agrees to accept responsibility for the conduct of the project or the part of the project being assisted through the Indiana Lions Foundation, Inc. The applicant also agrees to make a six (6) month report and a final report, complete with pictures if possible, within one (1) year of receipt of the Grant on the expenditure of funds.

Source of funds received by the foundation for the dedicated grant:

Donor's Name(Required)
Donor's Name
Donor's Name
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