Charity Ball Recipient Application 2017-18

Please complete the following application to be considered for a donation of this coming year's Charity Ball.

Organization Name
Charitable Registration Number
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Web Site
Contact Name (For Application) Contact Name (For Application) First Last
Contact E-Mail (For Application)
Contact Phone (For Application) Contact Phone (For Application) - ### - ### ####
Chair of Board of Directors Name Chair of Board of Directors Name First Last
Chair of Board of Directors Email
Chair of Board of Directors Phone Chair of Board of Directors Phone - ### - ### ####
Questions
1. Please clearly state the organization’s mandate or mission.
Maximum of 500 words allowed. Currently Entered: 0 words.
2. What are the long term and short term goals of your organization?
Maximum of 500 words allowed. Currently Entered: 0 words.
3. If selected as the charity of choice, please explain what the donation will be used for. Please
describe the breakdown of how the funding would be spent (ex. Percentage to charity, percentage
to administration, etc)
Maximum of 500 words allowed. Currently Entered: 0 words.
4. What programs or ideas have you put forward that will incorporate the Western community
into your organization? This can include volunteer opportunities, learning skills, and possible
collaborations.
Maximum of 500 words allowed. Currently Entered: 0 words.