Charitable Contribution Request

Legal Name of Organization Applying: *
(Should be same as on IRS determination letter and as supplied on IRS Form 990)

Program Area Served (check only one box) *

Geographical Areas Served (check all that apply) *

Project/Program/Event Title: *

Type of Project: *

Total Project/Program/Event Cost: $ *

Request Amount: *

Amount Raised to Date: *

Deadline by which the WCLG must commit in order to be listed as a sponsor in all printed materials: *

Please state how the funds will be directed, should the WCLG fulfill your request: *

If the WCLG fulfills your request, will you be able to provide data of results, and how the money was spent?: *