Special Funds Request Form
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Amount Requested: $ Amount Approved: $_________________
Trustee Recommendation: $___________________
Requesting Member: Assignment:
Home Phone Number: Pager Number:
Benefitting Organization:
Name of F.O.P. Member/Family Member in Program:
To What Capacity is Members Involvement:
Has this Request Been Funded Before: Amount: $

If F.O.P. members are involved, they must be willing to assist as volunteers for functions sponsored by the F.O.P. You will have to assist with at least one shift at the Oktober Fest which is the first weekend in October:

Reason for request and what the money will be used for:

If this request is for funding an adult team composed of one or more F.O.P. members, you must list the F.O.P. members below.

1. 2. 3.
4. 5. 6.
7. 8. 9.
10. 11. 12.
13. 14. 15.

Make Check Payable To:

Signature of Requestor: _____________________________________

TRUSTEES COMMITTEE APPROVAL AND RECOMMENDATION
APPROVE REJECT ABSENT
South _____ _____ _____
West _____ _____ _____
Midtown _____ _____ _____
East _____ _____ _____
I.S.B. _____ _____ _____
S.S.B. _____ _____ _____
Retired _____ _____ _____