Kiwanis Club of Banner Elk
PO Box 2321 Banner Elk NC 28604-2321
Form must be fully complete for consideration!
Name of Organization ________________________________ Date_____________
Email______________________________________ cell #_________________________
Mailing Address: _________________________________________________________
Principal/superintendent/organization officer: ______________________________________
Attach a one page typed or printed summary describing your project, including measurable objectives and how you will evaluate success.
Please show an income/expense budget identifying total fund sources and detailed expenses.
Amount requested____________ Total project cost____________
If Kiwanis cannot fully fund your request, is it possible that matching monies could provide complete funding? ________
Please be aware that the purpose of Kiwanis International, and this club, is
“To improve the quality of life for children and families worldwide.”
Age range of the person(s) to be served________ Number of person(s) benefiting _______
Duration of project____________________________________________________
References: Name 2 local persons (not employees) who are familiar with your organization/project:
****All school requests must be signed by principal or superintendent.****
****Organization requests must be signed by president/chief officer.****
I understand that an evaluation report is expected by June 30, 2022 if this project receives Kiwanis support and if I wish to apply for more funding in 2022
Applicant signature_______________________ Officer signature________________________