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:
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