Measure Up Campaign Report & Grant Form

 
Please complete and submite to the State Warden.  Instructions will be emailed for sending the check to the State Warden.  The full amount collected is to be forwarded by November 1.
 
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Collection & Donation Totals

Total Donation
$0.00

DISTRIBUTION PLAN

 
DISTRIBUTION RULES
 
1. Contributions must be made to an identified 501 C-3 organization(s), as described by the Internal Revenue Service.
2. Recipient organizations should be providing assistance or support to citizens with Developmental Disabilities within the local community or geographical area.
 
 
STATE COUNCIL CHECK TO BE MADE PAYABLE TO
(Please complete with organization’s full name for check.)
 OrganizationAddressCity, State, Zip% of Total Collection
1
2
3
4
5
6
7
8
9
10