Hanover Athletic Association

Application for Donation

Instructions:
Complete this form in its entirety. Please supply as much detailed information as possible.
Items marked with an *asterisk are required.

THIS FORM MUST BE RECEIVED BY THE FIRST WEDNESDAY OF THE MONTH TO BE ELIGIBLE FOR DONATIONS IN THAT MONTH.

Please provide the following contact information:

*Name:

Title:

Organization:

*Address:

Address (cont):

*City:

*State:

select

*Zip Code:

County:

*Phone:

Fax:

*e-Mail:

Web Site URL:

If this is an organization, are you involved in Charitable Gambling?

YesNo

Does your organization have any officers, board members, or members that are also members of the Hanover Athletic Association?	YesNo
If yes, please list names and positions within your organization:

Is this a scholarship request?

YesNo

*Amount Requested:

What is the total cost of the entire project?

*When is the donation needed by?

Open the calendar popup.

If the donation is approved, who should the check be made payable to?

*Proposal or reason for donation request:

If the donation is approved we will need a copy of the invoice(s) for any purchases made from the donation.

If the donation is approved and is for a school or unit of government you will need to complete a LG555 and have it signed by an official of the school or unit of government. Fill out the bottom portion of the form only.
Download the LG555 form here: http://www.gcb.state.mn.us/PDF_Files/lg555.pdf