Dr. Phillips Charities Eagle Service Project Application

Dr. Phillips Charities Eagle Service Project Application - Fund Request
Step 2
Complete the information below and submit the amount requested along with documentation certifying the amount and source of all secured matching funds.

Print a copy of the completed form prior to submitting.
District:*
Troop/Crew Number:*
Scout Name:*

First NameLast Name
Scout Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Dr. Phillips Grant Request $: *
Total funds currently secured towards project $: *
Note: List source of matching funds including donations, fundraisers and gifts in kind. *
Upon approval, a check will be issued in the name of the Eagle candidate. Please allow up to two weeks for this process to be completed.
Print a copy of this completed form before you submit. Keep this form with your files.
Should be Empty:

Dr. Phillips Charities Eagle Service Project Application - Fund Request