Assistance Grant Request

DIRECTIONS TO REQUEST ASSISTANCE
Complete the form as completely as possible to request cash assistance or assistance with a
purchase.
Plan to submit your request 45 days prior to your need by date. Requests submitted earlier are
better.
Please attach any quotes for purchases/services or additional information that will be useful in
review of the request.
If you plan to submit more than one request in a year (July – June) please prioritize your
submissions. Your first request should be the most needed – or you can submit all requests at one
time. EMERGENCY requests will be considered.
The St. Augustine Lions will accept requests for an individual, however, these requests must be for
a specific need. For example, medical equipment, home repair, youth leadership/academic
opportunity. Note – these requests are fulfilled by paying the vendor directly.

Submit the following for consideration

Please be sure we can contact the person listed on the form with any questions about the request.

Requesting for (circle one) Organization OR Individual Assistance Requests to help an individual MUST include business or organization for payment.
Quote, invoice or other documents must be attached.

**Please provide name and address below of person to send donation if approved.