1235 Summerwood Circle

Wellington, Fl 33414

(561) 215-3717

 

INDIVIDUAL DONATION REQUEST FORM

(Please print clearly)

 

 

Name: Last ____________________  First: __________________Middle : ____________

 

Address: _____________________________ City: _________ State: ____ Zip: _________

 

Male: ___ Female: ___ Date of Birth: __________ Phone #:  (        ) __________________

 

Email: _____________________________ To Be Used for: _________________________

 

League Name: __________________________________ Registration Cost: $ _________

 

Contributing Parties:

 

Amount requested: $ _________ League Contribution: $ _________ Parent: $ _________

 

Please write a small summary as to why this donation is requested: (to be completed by youth or parent of youth)

 

 

 

I give the Tyler McLellan Foundation permission to use my name, any photographs and writings provided to the organization to be used in any of its publication materials, reports, press releases, web site, and activities associated with the foundation.

 

The undersigned hereby acknowledges the information provided on this application, including attachments is true and correct to the best of his/her knowledge.

 

Applicant Signature: _______________________________________________  Date: ________________

 

Parent Signature: __________________________________________________ Date: ________________

 

Coaches Signature : ________________________________________________Date: _________________

 

Coach Print Name : _____________________________________________Phone # __________________

                      

 

 

APPLICATIONS MUST BE SUBMITTED BY US MAIL.  ANY OTHER MEANS WILL BE INVALID FOR REVIEW. BY THE BOARD.

 

 

www.tylermclellanfoundation.org                                                   [email protected]

     

 

                

 

 

1235 Summerwood Circle

Wellington, Fl 33414

(561) 215-3717

 

 

 

Application Criteria

 

 

 

•       Application must be fully completed.

 

•       Applicants must show a need for assistance

 

•       Single Parent Household income cannot exceed $21,000.00

 

•        Two Parent Household income cannot exceed $42,000.00

 

•        Must provide a copy (front page) of last years IRS 1040 tax return

 

•       If a parent or parent’s aren’t able to contribute a percentage of the cost, they must volunteer a mutually      agreed amount of hours for said organization.

 

•       All documents requested must be attached to application

 

•       Copied applications are not accepted.

 

•       Applications must be submitted during funding periods to be considered.

 

 

 

 

 

 

 

* The Tyler McLellan Foundation reserves the right to disqualify any applicant if all documents are not  complete or attached with application.

 

 

 

 

 

 

 

 

 

www.tylermclellanfoundation.org                                                               [email protected]