Beale Officers' Spouses Club PSC Box 0099 Beale AFB, CA 95903

Requests must be submitted by the last day of each month for consideration at the

following month's board meeting.

APPLICATION FOR CIIARITABLE CONTRIBUTIONS

Date of Request: Name of Organization:
Address:

Date Funds are Needed:

Point of Contact: Ext: Phone: _

Altemate Phone:

Ext.

Amount Requested:

Yes

Yesn 2. Is your Organizationtax-exempt? - If yes, please provide Taxpayer Identification Number: 3. Source offinancial support: 4. Please tell us about the purpose of your organization, types of activities, number of persons service, etc...:
5. Specific purpose for which requested funds will be used: 6. Total budget for this purpose: 7. Who willbenefit from these funds? 8. Please list other orgarizations solicited for this pu{pose, and the amount
Or

Is your Organization a charity of non-profit?

fl

n NoI
No

requested:

ganization/ Amount Requested

/ / /

9. If request is approved, check should be made payable to:

10. Please provide any additional information which may assist in the decision process.