Charity of Choice Application

Contact Information

* Contact Name

* Phone
xxx-xxx-xxxx

* Email

Organization Information

* Organization

* Address

* City

* Postal Code

* Website

* Registered Charity Number

Request Information

* Organization's mission, vision, or values statement

* Briefly describe the services you provide in the community

* What age groups do you serve?

* How many clients / residents are served annually by your programs / organization?
residents served per year

* Amount requested

* How will the funds received make a positive impact on the community?

* Most recent annual report
Files can be no larger than 5 MB, pdf, doc(x), xls(x) or txt files only

Past Donations

* Have you received a donation from the Chair's Charity Golf Tournament in the past? Yes
No

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.