Grant Application — Dan Leach Memorial Fund

Apply for a Grant

Submission of an application to the Dan Leach Memorial Fund does not guarantee approval or grant funding. The Fund retains full discretion over the acceptance of applicants and the awarding of grants. All decisions made by the Fund are final and based on internal criteria and available resources.

Name

First Name

Last Name

Date of birth

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Contact name & number of person/organization that referred you to DLMF:

Name of school grantee currently attends:

*Please note we will require proof of enrollment from your school (Infinite Campus student summary or similar proof from private school)

Grade

Activity Data

Please note: incomplete applications will not be considered

Name of activity/camp/course

Date

Location

Activity Cost

Total cost of the activity for the child to attend/participate

Amount Requested

Total amount you need DLMF to provide

Check made out to

Explain in detail why you/grantee wishes to participate in this activity

Grades 6 & up

Explain your efforts to raise money for this program (i.e. fundraising)

Financial Data

Please note: further information may be requested The need for financial assistance is the criteria under which grants from the Dan Leach Memorial Fund are awarded. Our Board of Directors reviews the financial circumstances of every applicant before making a decision and relies on the following to make a wise choice.

Name of parent/guardian(s)

Address (if different from child's)

Occupation of Parent/Guardian #1

Employer

Annual Salary

Occupation of Parent/Guardian #2

Employer

Annual Salary

Number of adults (18+) residing at the same address (including parents/guardians above)

Number of dependent children residing in family

Please include any additional household or financial circumstances that may pertain to this application

Apply for a Grant

Thank you for your support.