sarah porter beckwith fund, incorporated

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IOWA P.E.O. PROJECT FUND, INC.
Sarah Porter Beckwith Friendship Fund
β€œTo provide for the health, education, welfare, maintenance and support of any deserving person.”
APPLICATION for FINANCIAL AID
Sections in bold must be completed or application will be returned.
Application must be submitted within 60 days of Chapter vote.
(Set all printer margins to 0.5 inches – top, bottom, left, right)
1.
2.
Name (please print) ____________________________________________________________________________
(Last)
(First)
(Middle)
Address ________________________________________ City __________________________ State____ Zip _______
3.
Phone (H) ______________________ (W) ____________________
Date of Birth _____________________________
4. Total Amount requested $____________________
Describe in detail how the funds will be used (continue on another page if necessary):
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
5.
Date aid is needed: __________________________
6.
Paid:
7.
Send Payment to:
One time
$___________ per month for ____ months (max 12)
Applicant
Other: _________________________
Person/Company below (add additional page if more than one recipient):
Name/Title:_________________________________________________________________________________________
Address:____________________________________________________________________________________________
8.
List other sources of assistance the chapter or individual has contacted. __________________________________________
____________________________________________________________________________________________________
9.
Next of kin, Guardian, Bank Trust Officer, or person holding Power of Attorney:
Name/Relationship:___________________________________________________________________________________
Address:____________________________________________________________________________________________
===================================================================================
CHAPTER VOTE:
Applicant recommended by: Chapter ___ City ___________________ Date of Meeting ___________________
Number present ________ Number Pro __________ Number Con _______
________________________________________
(signature of President)
Email: _________________________________________
________________________________________
(signature of Recording Secretary)
Email: _________________________________________
(A written ballot is suggested)
________________________________________________
(Name of Chapter Contact Member)
Address_______________________________________________
City, ST _______________________________ Zip___________
Home Phone __________________________________________
Email: ______________________________________________
===================================================================================
TO BE COMPLETED BY SUBMITTING CHAPTER FOR EDUCATIONAL APPLICATION:
If the applicant is a woman, does she qualify for assistance from ELF? ________ or PCE? _________
If yes, does the chapter plan to submit her to that program as well? (Please attach detailed explanation)
Return form and attachments to: Deb Gaskill, 102 N Oak St., Lake Mills, IA 50450-1326
06/14
[email protected]
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