Request for Funding

Each year the Tri-State Hot Stove League takes a portion of the money raised from the Night of Memories and donates it to local organizations. If your organization is interested in being considered for this funding, please complete the form below. Applications are due by March 1, 2019.

Organization Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Contact Person*
First Last
Phone*
Email*
How long has your organization been in existence?*
Is your organization Incorporated?*
- Yes
- No
501c(3) Tax Exempt?*
- Yes
- No
What geographic area do you serve?*
Ages of youth served.*
- 5-12 Years
- 13-18 Years
- 19+ Years
Number of Youth Served*
Main activity or purpose.*
Dollar amount requested?*
How will the funds be used?*
Total annual budget for your organization?*
Will these funds take the place or be in addition to current funding?*
Officers of Organization
President*
First Last
Vice-President*
First Last
Secretary*
First Last
Treasurer*
First Last
Comments
This field is for validation purposes and should be left unchanged.

Request for Funding

Officers of Organization

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