2027 Senior Levy SOCIAL GROUP/CLUB Funding Application

2027 Senior Levy SOCIAL GROUP/CLUB Funding Application

Complete each page, upload the required documents, and certify your information before submitting. Please email seniorlevy@lcap.org with any questions.
SocialGroup/Club
Applicant Name

First NameMiddle NameLast Name
Club Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Club Phone
Please enter a valid phone number.Format: (000) 000-0000.
Club Email
example@example.com
Club Meeting Location
Club Meeting Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Meeting Date and Time
Club Activities

Please answer all questions to the best of your knowledge. If a question is not applicable to your organization/agency, please indicate NOT APPLICABLE – N/A.
Tell us about your club. What types of activities and programs do your members expect and enjoy?
Describe the process and/or tools used to track, report and ensure that senior levy funds serve only Licking County residents over the age of 60?
How many active members do you have? (Active members are defined as those who participate in more than 50% of club activities.)
What was the average meeting attendance for your club from January - June 2026?
Was there a decrease or increase in membership for 2026? If so, please describe any recruitment activities and public awareness efforts.
How many meals have your members enjoyed so far in 2026 that were paid for with Senior Levy funds?
Club Budget
Is your club’s checking/savings account regularly reconciled?
If yes, how often?
Who performs this function?
What is the procedure to address any financial record keeping issues?
Were any levy funds carried over from 2024–2026?
Carried Over Amount (USD)
If so, explain how these reserves are used.
List other sources other sources and amounts of revenue/income raised during the year and spent on club activities in 2026.
List any projected revenue/income from these sources (and others) that you expect to receive in 2027.
Does your club charge any membership dues?
If yes, how much?
How are the club's membership dues spent?
How much are you requesting in funds for 2027?

2027 Budget Request (If you want to submit your own copy and not use this table, you may attach it at end of application)

Rows	Amount of Levy Funds Used as of June 2026	Amount of Levy Funds Requested for 2027
Rent
Utilities
Food/Nutrition
Supplies/Operating Expenses
Other
Other
Other

Attachments and Additional Items
Club’s 2026 financial statement (through June 30, 2026) or bank statement that includes detailed information on how Senior Levy funds were spent so far this year.

Cancelof
Tentative meeting/activity schedule for 2027, if available.

Cancelof
2027 Proposed Budget Request (if above form did not work or you want to attach your own)

Cancelof
List of Board of Directors

Cancelof
Agreement to Certification Statement

I certify that this application is true and correct. If awarded Senior Levy funding, I understand that our organization must enter into a Senior Citizens Levy Agreement with the Board of County Commissioners. Grantee must also remain in compliance throughout the term of said agreement. Once the Board of Commissioners approves the recommended 2026 Senior Levy allocation distribution from the Licking County Aging Partners’ Senior Levy Allocations Committee, an Agreement will then be sent to the Grantee to complete and return.
Certification Statement
Club President Name

First NameMiddle NameLast Name
Date
Should be Empty:

2027 Senior Levy SOCIAL GROUP/CLUB Funding Application

Club Activities

Club Budget

Attachments and Additional Items