Optimist Clubs may use this application and attach additional pages as needed. Incomplete
applications will be returned to the contact person listed on this application for completion and will
not be reviewed. Applications should be submitted after Club/District has approved project. Clubs
may submit one CCC matching grant request per Optimist year.
These funds are intended to be used for Optimist Club projects and not to fund other Foundations and/or organization’s
programs. Projects can only be submitted for grant consideration once, regardless of whether they are ongoing projects.
Club/District Name: __________________ Number: ____________________________________________
Contact Person: _______________________________ Last Name: _______________________________
Mailing Address: _________________________________________________________________________
City: _________________________ State/Province: ____________________________________________
ZIP/Postal Code: ___________________ Country: ____________________________________________
Phone: ______________________________ E-mail: ____________________________________________
Please provide a brief description of the project below & anticipated cost of project:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Is project annual or ongoing? ________ If annual, how many years has it been run? ______
Date of Current Project ____________ Grant Amount Requested: $___________
How much Club/District money has been raised for the current project?______________
(Please do not list amount raised for project during total number of years it has been conducted).
What is the goal of the project?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Childhood Cancer Campaign
Club and District Matching Grant Applicaon
Why did your Club choose to allocate the funds in this way?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will this goal be achieved?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How would this grant allow the project to achieve something not possible in the past?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will the project impact children with cancer, their families and/or their caregivers?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will this project impact the Childhood Cancer Campaign?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How did you hear about the CCC Matching grant program?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
In order for this application to be complete the following documents must be attached:
1. A Project budget detailing project expenses and anticipated income sources.
2. A list of the members of your Board of Directors or District Officers including names & titles.
It is the decision of the Advisory Panel to grant either the full or a portion of the amount requested.
Only the amount requested or a portion of that amount will be granted. 50% of the amount granted
will be paid upon approval with 50% being paid after all paperwork and final report have been
received by Optimist International. Grant checks will be sent to the Club or District Treasurer. The
minimum amount grant requested is $250.00 with a maximum grant being $1,000.00. Projects
designed to fund other Foundations and/or organizations will not be considered. ALL
decisions of the Advisory Panel are final.
Send completed application to:
Optimist International, c/o CCC
4494 Lindell Blvd., St. Louis, MO 63108
Fax: (314) 371-6006 • ccc@optimist.org
ADVISORY PANEL APPROVAL
Date report received: _____________________________________________________________________
Conditions of approval (procedures to follow or specific instructions): ___________________________
________________________________________________________________________________________
PROJECT NAME: ________________________________________________________________________
PROJECT NUMBER: _____________________________________________________________________
Optimist Clubs may use this application and attach additional pages as needed. Incomplete
applications will be returned to the contact person listed on this application for completion and will
not be reviewed. Applications should be submitted after Club/District has approved project. Clubs
may submit one CCC matching grant request per Optimist year.
These funds are intended to be used for Optimist Club projects and not to fund other Foundations and/or organization’s
programs. Projects can only be submitted for grant consideration once, regardless of whether they are ongoing projects.
Club/District Name: __________________ Number: ____________________________________________
Contact Person: _______________________________ Last Name: _______________________________
Mailing Address: _________________________________________________________________________
City: _________________________ State/Province: ____________________________________________
ZIP/Postal Code: ___________________ Country: ____________________________________________
Phone: ______________________________ E-mail: ____________________________________________
Please provide a brief description of the project below & anticipated cost of project:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Is project annual or ongoing? ________ If annual, how many years has it been run? ______
Date of Current Project ____________ Grant Amount Requested: $___________
How much Club/District money has been raised for the current project?______________
(Please do not list amount raised for project during total number of years it has been conducted).
What is the goal of the project?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Why did your Club choose to allocate the funds in this way?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will this goal be achieved?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How would this grant allow the project to achieve something not possible in the past?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will the project impact children with cancer, their families and/or their caregivers?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will this project impact the Childhood Cancer Campaign?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How did you hear about the CCC Matching grant program?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
In order for this application to be complete the following documents must be attached:
1. A Project budget detailing project expenses and anticipated income sources.
2. A list of the members of your Board of Directors or District Officers including names & titles.
It is the decision of the Advisory Panel to grant either the full or a portion of the amount requested.
Only the amount requested or a portion of that amount will be granted. 50% of the amount granted
will be paid upon approval with 50% being paid after all paperwork and final report have been
received by Optimist International. Grant checks will be sent to the Club or District Treasurer. The
minimum amount grant requested is $250.00 with a maximum grant being $1,000.00. Projects
designed to fund other Foundations and/or organizations will not be considered. ALL
decisions of the Advisory Panel are final.
Send completed application to:
Optimist International, c/o CCC
4494 Lindell Blvd., St. Louis, MO 63108
Fax: (314) 371-6006 • ccc@optimist.org
ADVISORY PANEL APPROVAL
Date report received: _____________________________________________________________________
Conditions of approval (procedures to follow or specific instructions): ___________________________
________________________________________________________________________________________
PROJECT NAME: ________________________________________________________________________
PROJECT NUMBER: _____________________________________________________________________
Optimist Clubs may use this application and attach additional pages as needed. Incomplete
applications will be returned to the contact person listed on this application for completion and will
not be reviewed. Applications should be submitted after Club/District has approved project. Clubs
may submit one CCC matching grant request per Optimist year.
These funds are intended to be used for Optimist Club projects and not to fund other Foundations and/or organization’s
programs. Projects can only be submitted for grant consideration once, regardless of whether they are ongoing projects.
Club/District Name: __________________ Number: ____________________________________________
Contact Person: _______________________________ Last Name: _______________________________
Mailing Address: _________________________________________________________________________
City: _________________________ State/Province: ____________________________________________
ZIP/Postal Code: ___________________ Country: ____________________________________________
Phone: ______________________________ E-mail: ____________________________________________
Please provide a brief description of the project below & anticipated cost of project:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Is project annual or ongoing? ________ If annual, how many years has it been run? ______
Date of Current Project ____________ Grant Amount Requested: $___________
How much Club/District money has been raised for the current project?______________
(Please do not list amount raised for project during total number of years it has been conducted).
What is the goal of the project?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Why did your Club choose to allocate the funds in this way?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will this goal be achieved?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How would this grant allow the project to achieve something not possible in the past?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will the project impact children with cancer, their families and/or their caregivers?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How will this project impact the Childhood Cancer Campaign?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
How did you hear about the CCC Matching grant program?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
In order for this application to be complete the following documents must be attached:
1. A Project budget detailing project expenses and anticipated income sources.
2. A list of the members of your Board of Directors or District Officers including names & titles.
It is the decision of the Advisory Panel to grant either the full or a portion of the amount requested.
Only the amount requested or a portion of that amount will be granted. 50% of the amount granted
will be paid upon approval with 50% being paid after all paperwork and final report have been
received by Optimist International. Grant checks will be sent to the Club or District Treasurer. The
minimum amount grant requested is $250.00 with a maximum grant being $1,000.00. Projects
designed to fund other Foundations and/or organizations will not be considered. ALL
decisions of the Advisory Panel are final.
Send completed application to:
Optimist International, c/o CCC
4494 Lindell Blvd., St. Louis, MO 63108
Fax: (314) 371-6006 • ccc@optimist.org
ADVISORY PANEL APPROVAL
Date report received: _____________________________________________________________________
Conditions of approval (procedures to follow or specific instructions): ___________________________
________________________________________________________________________________________
PROJECT NAME: ________________________________________________________________________
PROJECT NUMBER: _____________________________________________________________________