Financial Asst Request Form

IMPORTANT: This year due to COVID there will be no in person presentations. All information must be turned in with the form below. 

The new form attached is what the Creston Community Service Club needs to process any requests for financial assistance.  Please fill out this form and return it to CCSC c/o H. Uhler, 202 S Crestview Dr., Creston, OH 44217 on or before November 20thth

Thank you for your help.

Creston Community Service Club

Request for Financial Assistance

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To be considered for funding from the Creston Community Service Club, the following questions need to be answered and returned to CCSC, c/o H. Uhler,  202 S Crestview Dr.,, Creston, OH  44217 on or before Nov. 20th  Thank you.                    

Name of Organization: _______________________________________________________

Contact Person: _____________________________________Phone: __________________

Address: __________________________________________________________________

Email address: ___________________________   Number of Individuals in the program ____ 

You are a:      School Program ____   Community Program ____    Private Organization ____

                     New Program ____    Existing Program ____

Organizations yearly income ________________        Organizations yearly expenses _________________

Primary source of funding comes from: ________________________________________________

List Fund Raisers that your organization has done or plans to do in the current year: ___________

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Your request for funds from the CCSC will be used for the purpose of:_______________________

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Does your organization help at the Creston Ox Roast, if yes, please explain: ______________________

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Additional Comments: ______________________________________________________________

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_______________________________________________         ____________________________                                Signature                                                               Date