Recipient Request – Maine Knights of Columbus

Note: This is NOT a printable form. You will receive a copy in your email, and a copy will go the the Program Director.

Tootsie Recipient

“Program for People with Disabilities” Recipient Submission Form

NOTE: Deadline for requesting funds is December 15, 2024

This form will be submitted to Anthony S. Alfiero, Faith in Action Director.

A copy will also be emailed to the email address provided on this form as confirmation of submitting.

Request for funds to be distributed:

Council #

Date Funds to be distributed (not to exceed 45 days prior. Allow 2 weeks for delivery.)

Council Name

Grand Knight's Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter Email Confirm Email

Please issue check(s) for our Council’s portion of the drive proceeds as shown below.

Check 1

Amount

Check 2

Amount

Check 3

Amount

Check 4

Amount

Check 5

Amount

Check MUST be made out to the recipient of the gift. The check(s) will be mailed to the Council Grand Knight (unless otherwise designated) for presentation to the recipient(s) unless otherwise specified.

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