APPLICATION FOR ASSISTANCE – The Beacon Charitable Corporation

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The Beacon Charitable Corporation

APPLICATION FOR ASSISTANCE

Name of applicant:

Applicant Contact information:

*Name of Nominee:

*Nominee contact information:

Why applicant is applying for financial assistance:

**Please use a separate piece of paper to tell us as much as you can about your request for financial assistance. Our board of directors will make the final decision based on the information you provide. ** we do not disburse funds directly to applicant/nominee, there must be a legitimate organization or debtor that will receive payment for services rendered or debts owed. * = if applicable

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