District Seven
Altrusa International, Inc.
Club Revitalization Grant Program
Submit completed form to Governor Olivia Haringa.

Date:

Submitted by: Altrusa International, Inc. of

Please provide the following contact information:

President's Name
Street Address
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail

Number of Club Members excluding emeritus as of application date:

Has Club adopted and implemented a strategic plan?

Yes No

If "yes", when was it adopted??

If "no", is a plan currently being developed??

Yes No

Date of last recruitment event?:

Date of last orientation/reorientation program?

Please describe your major obstacle to growth in membership:

Funds may be used for such things as printing of invitations or brochures for recruitment events, postage, refreshments for recruitment events, travel expenses (mileage) for District Representative, advertisements in local media outlets, etc.  All funds will be paid as reimbursements for approved expenses.  Submit Vouchers to District Treasurer within 30 days of expenditure for reimbursement.  The District Board will make every attempt to award funding as requested, but may only be able to grant a portion of the funds requested.

Please explain how funds will be used:

DOLLAR AMOUNT REQUESTED

What do you think District Seven can do for you to help?

I certify that I am the President of the above named club.