Saskatchewan Lotteries

Community Grant Program

Application Form

Organization Name

What are your organization's Mission and Vision statements?

When was the Organization incorporated/founded in Yorkton?

Address

Postal Code

Primary Contact Person

Position/Job Title

Phone Number

E-mail

Alternate Contact Person

Position/Job Title

Phone Number

E-mail

Project Title

Grant Amount Request (maximum $5,000.00)

Project Start Date

Project Completion Date

Please provide a brief project description: (bullet points are acceptable)

Authorized Representative Name

Position

I agree to the terms as listed above and that I am the authorized representative for the Organization recorded above.

Clear

Date