4-H Income Generation Application Directions: Use this form for fundraisers – including solicited donations. Do NOT use this for grants. If you are considering applying for a grant contact your 4-H PC/PD. To obtain permission to raise any funds in the name of 4-H, complete and return this form to 4-H PC/PD no less than 10 days prior to soliciting the funds. Club/Group Name: Phone: Address: ______________________________________________________________________ Person making request: Phone: Date Request Made: ___________________________________________ Proposed use of the funds: ________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Date(s) of activity: What is the proposed activity? When is the proposed activity to take place? Where is the proposed activity to be held? What are the life skills the youth will learn or experience (ie: public relations, bookkeeping, salesmanship, etc.)? __________ _______ ______________________________ If asking for donations, please attach a list of who you plan to contact for donations. Keep a copy for your group’s records. For Office Use Only: Approved:______________________ Non-approved: Date: Staff Signature: The University of Minnesota is an equal opportunity educator and employer. For Americans with Disabilities Act Accommodations, please call 1-800-444-4238. www.extension.umn.edu