Initial Request Form

This form is for an initial or pre-approval request for financial assistance from the Pennsylvania Veterans Assistance Fund (PVAF) in accordance with PVAF's Grant Application Policy & Procedures.

REQUESTED BY:

Name: ____________________________________________        Chapter _______________

Address: ___________________________________________________________________

Telephone: _________________________  E-Mail:__________________________________

NAME OF PROJECT: _________________________________________________________

DATE OF PROJECT: _______/________/_________

TOTAL PROJECT COST (Estimated): $____________________________

GRANT AMOUNT REQUESTED:  $______________________________

Brief Description of Project:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

ADDITIONAL GRANTS REQUESTED:                                 AMOUNT (Requested or Approved: Name of Organization and Amount  $ ____________________________

Approved: Name of Organization and Amount $________________________ 

____________________________________________________     _______________________

PVAF Officer                               Title                                                             Date

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FOR PVAF

APPROVED / DENIED          AMOUNT: $__________________   DATE: ____/_____/_______