HEIDELBERG COMMUNITY AND SPOUSES' CLUB
CMR 419, BOX 1643,
APO  AE  09102

FAX: 06221-763085
Phone:  015226585803

EMAIL: WELFARE@HCSC-HEIDELBERG.COM
2011-2012 Welfare Grant Application
This form must accompany your request for a donation from the Heidelberg Community and Spouses’ Club
(HCSC).  Failure to complete all portions of this form will cause your request to be delayed or denied.  Provide as
much detailed information as possible.  Additional enclosures or letters are accepted.

This application should reach HCSC Attn: Welfare Chair by the established deadlines below by either fax or mail:

Block 1 Grants (Oct 2011 – Jan 2012)   Deadline: Thurs, 15 Sept 2011
Block 2 Grants (Feb 2012 - May 2012)    Deadline: Thurs, 19 Jan 2012
Block 3 Grants (May 2012 – Sep 2012)  Deadline:  Thurs, 06 Apr 2012


WARNING: DO NOT USE THE ENTER KEY BETWEEN FIELDS - USE ONLY THE TAB KEY!!
SECTION A
Amount
Requested:
Date of Request:
Organization Name:
APO
Address
:
Head of Organization (name):
Title:
Point of Contact (Person held responsible for completing the grant process)
Name & Position:
Phone
Number(s):
Email
Address:
SECTION B
1st Grant Application for your organization.  If checked, proceed to Section C
Complete this section only if your organization has received HCSC Welfare funds at any time during the
past.  Please provide details on each project, disbursement and the status of the monies granted.  Only
organizations in “Good Standing” will be considered for Welfare grants.
Project Name:
Amount Received
$
Date Received:
**Status**
Good Standing
 Delinquent / Suspension Pending    
 Suspended
______________________________________________________________________________________________
Project Name:
 Date Received:
Amount Received
$
Good Standing
**Status**
 Delinquent / Suspension Pending    
Suspended
______________________________________________________________________________________________
SECTION C
Date of Event / Project:
Description of Event / Project:
Estimated Number of People to Participate
Amount to be Paid by Individual Participant
Estimated Total Cost of Event / Project
Amount Provided by Fundraisers
Amount Requested from Other Organizations
Amount Received from Other Organizations
Please answer the following questions completely but limit each answer to 50 words or less.  
Complete answers on all questions will expedite the Welfare process.
Questions 1- 5 pertain to your organization.
1.  What is the purpose of your organization?
2.  What are your membership requirements/restrictions?  How many members does your organization
currently have? Do they pay dues?  
3.  How is your organization financially supported?
4.  Is your organization eligible for MWR or DoDDs support?
5.  Has your organization volunteered at the annual HCSC Holiday Bazaar?  or HCSC
Thrift Shop?  
Questions 6- 12 pertain to the specific request.
6.  What is the purpose of the funds? (please provide a breakdown of project expenses)
7.  If this request is approved, who will benefit from these funds and in what manner?  Please be
specific.
8.  When are the funds needed?
9.  What is your organization's contribution and is your organization doing any fundraising?  Explain.
10.  Have you secured funds from other sources already?
11.  Are you requesting funds from other sources? If yes, please provide details.  If no, please explain
why?
12.  Is the request a necessity or nicety?  Please explain.
If the request is approved, make check payable to:
Please note: Checks will not be made out to individual requestors but rather to their organizations.  The check
will be made payable to the organizational name stated here.  Please verify before forwarding the application that
your organization can receive funds.  Checks will not be reissued.
Proper authorization on each request must be obtained.  If the request is from an MWR organization, the
MWR Commander or Deputy commander's signature is required.  Otherwise, Unit, Clinic Commander's or
President's signature is required.  If the request is from DoDDs, signatures from the PTA/PTO President and
Principal are required.
Requestor’s Name and Position:
Approving Authority’s Name and
Position:
By clicking Send Now, I agree to send a signed hard copy of this application within 5 business
days to the Welfare Chair via MPS,  or personal delivery.