MHOSC Welfare Request
Position in Organization:
City, State, Zip
Describe the Project/Activity for which the funds are being requested
Total Funding Needed
Amount requested from MHOSC
Has the MHOSC supported this project/activity in the past? When?
How else is the project/activity being funded? How much has already been raised?
Date the funding is needed
How many individuals will benefit from this funding?
If funded, who should the check be made out to?
I will be submitting supporting documents in a separate e-mail. Flyers budgets or receipts may be submitted to email@example.com**please include project name in subject title**
Statement of Intent (required) In the even that my application is accepted and my program is funded by the MHOSC, I agree to use the funds only for the activities or programs described above. If the above activity or program does not occur as planned, or if the funding is no longer needed, I personally commit that the funds will be returned to the MHOSC and will not be used for any other purpose.
**Applications must be received by 5:00pm 2 weeks prior to the next monthly board meeting, which is held the first Tuesday of the month. If received after this deadline it will be addressed the following month.**
Should be Empty: