Apply For Individual Funding

If the intended beneficiary of the funds is not you, provide the full name of the beneficiary and contact info.

If you are applying for someone, what is your relationship to the beneficiary?

First Name

Last Name

Email Address

Phone Number

Street Address
Street Address Line 2

City

Province

Postal Code

Beneficary's First Name *

Beneficary's Last Name *

Beneficary's Email Address *

Beneficary's Phone Number *

Beneficary's Address Street Address *
Street Address Line 2

City *

Province *

Postal Code *

If request is granted, how will the money be spent? eg. purchase wheelchair, supplies for program, etc. (max. 1,500 characters) *

How much money are you requesting? *

Please explain the financial circumstances of the beneficiary. Why does the beneficiary need the money? (max. 1,500 characters) *

Have you approached other funding sources i.e. service clubs, government funding? *Yes, I have.No, I have not.

If Yes, Who?

If No, Why?

What was the result of your application to other funding sources? (max. 1,500 characters)

Please attach any supporting documentation you wish us to consider with your application. (File size must be under 5mb. Click the X to remove a file, if needed.)

Do you have any other information you would like to share regarding this application? (max. 1,500 characters)