Club Funding Form

Club Name:

Designated Representative's First and Last Name:



Recommended Funding Amounts Based on Membership:
The average # of attendees:     Amount: 
10 or less members   $30 monthly/$360 annually
 11-25   $120 monthly/$1,440 annually
 26 plus   Up to $280 monthly/$3,360 annually

Criteria for Approval:
All clubs must meet the following criteria to be considered eligible for funding. The submission of this application does not guarantee funding. Monetary contributions are at the sole discretion of the LiveDAYBREAK Board. Each application must be submitted one week prior to the monthly LiveDAYBREAK Board meeting. If approved, funding may take up to 30 days. Funding will be awarded once per year. Applications must be submitted yearly for continued funding. Additional funding may be requested, however, it may not be granted.

Is this an official Daybreak Club?
Yes or No

How will the funds be used? 
Please Explain.

What are the two or three of the LiveDAYBREAK pillars that your club meets (Connectivity, Lifelong Learning, Embracing Arts and Diversity, Healthy Living and/or Giving Back)?

How many people currently attend on a monthly basis?
Please explain.

What is the amount you are requesting?
Please explain.
If you are requesting greater funding than the amounts recommended above, do you have at least 6 months of a detailed accounting record?
If no, please explain.


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