Please fill out all information below (Part I and Part II)
PART I
Personal Information
Name: (first, last)___________________________________________________
Preferred Name: ___________________________________________________
Address: _________________________________________________________
City, State, and Zip: ________________________________________________
Email: ___________________________________________________________
Home Phone: _____________________________________________________
Sex Male □ Female □
Race/Ethnicity: (optional)_____________________________________________
Country of Citizenship: ______________________________________________
PART II
Grant Recipient Explanation
In the space below please provide a detailed explanation of your intentions of use for a Humanitarian Fund grant award and how much you would like to receive for that purpose.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please note that the amount requested might not be the
actual amount given if the application is accepted. Our awards are given
based on the availability of funds.
This application can either be printed, filled out and mailed to:
Piedmont Silver Eagles Charitable Funds, Inc.
Capt. Stephanie Hamilton
Humanitarian Fund
13115 Centennial Commons Parkway, Huntersville, NC 28078-4605 (704) 766-0957
Or this application can be E-mailed to humanitarian@piedmontsilvereagles.org
Your E-mail will be confirmed by auto response; messages are checked daily
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