Exchange Club of Aurora
Donation Request Application

The Mission of the Exchange Club of Aurora, Illinois: Exchange is a group of men and women working to make America a better place to live through our national project, the prevention of child abuse, and other community service projects.

A. Organization Information

1. How does your organization provide service to the community; does it serve specifically to assist you or in the prevention of child abuse?
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2. Organization Purpose/Mission:
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3. Name of Organization: _________________________________________________________________________

4. Contact Person: ______________________________________________________________________________

5. Address: ____________________________________________________________________________________

6. Telephone: (     ) ____________________  Fax Number: (     ) ____________________

7. Geographic Service Area: _________________________________________________

8. Number of persons served last year: _________________________________________

 

B. Funding Request:

1. Amount Requested: _______________________________

2. Specific Purpose:
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3. Specific and detailed description of how your program or project operates in accomplishing the purpose:
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4. Number of people who will be served by this project: _________________________________________

5. Is this a program or project that should be continued in subsequent years or a "one time" need? If it is a continuous program or project, please project length of time and future dollar amounts:
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6. How is the outcome of the program measured?
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7. What was the outcome if the program was in effect in previous years?
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8. Other funding sources for your program:
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9. Would your organization be willing to have a representative speak at an Exchange Clup of Aurora, Illinois meeting to update members on your program or project? _____Yes _____No

NOTE: Please attach any pertinent information regarding specific programs or projects these funds will be used for as well as a copy of your IRS 501c(3) status.. Please send this application to the following address:

Exchange Club of Aurora
c/o Robert J. O'Connor
Post Office Box 908
Aurora, IL 60507

Applications for donations are due on or before May 1, 2008. Notification of awards will be made by June 1, 2008.