LCIF Emergency Grant Online Application
This online emergency grant application may only be completed and submitted by the current District Governor in the wake of disasters where more than 100 people have been impacted and/or displaced in the District. The LCIF Emergency grant program supports Lions-led service activities that provide immediate needs and relief aid to victims of natural disasters. Grants, up to US$10,000, may be requested in the wake of natural disasters such as earthquakes, tornadoes, monsoon, typhoons, cyclones, wildfires, hurricanes, flooding, tsunamis, and similar events. Emergency grants are not eligible for famine, drought, infestations, man-made disasters, political strife, random acts of violence, pandemics, or random unfortunate events. LCIF is not a primary relief agency and these situations are more appropriately addressed by other agencies that exist principally to address those special needs. In some circumstances, support may be available through designated funds or where eligible, the District and Club Community Impact grant program. Submission of this request and confirmation of receipt does not indicate approval. The request will be reviewed by LCIF and the District may be contacted with additional questions by the Regional Program Specialist for the region. Relief activities that take place prior to approval are the sole financial responsibility of the local Lions, as LCIF will not consider grants on a reimbursement basis.
Email addresses of other individuals who should be copied on the LCIF reply to this application (where applicable)
What type of disaster occurred?
If you selected "other" what type of disaster occurred?
How much grant funding are you requesting? (Emergency Grants do not exceed US$10,000)
1. a). When did the disaster occur? (up to 30 days after occurrence)
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1. b). Where in your district did the disaster occur? (Specify cities, counties, villages, etc.)
2. a). What is the extent of local damages?
2. b). How many people were injured?
2. c). How many deaths occurred?
3. a). How many people are directly affected by this disaster? (Ex. the number of people impacted)?
3. b). How many of those people have been displaced or relocated from their homes?
4. a). Explain the current relief efforts underway being implemented by the community.
4. b). Explain the current relief efforts underway being implemented by the government.
4. c). Explain the current relief efforts underway being implemented by the local Lions.
5. What type of relief is planned? Explain what will be done, how the beneficiaries will be identified, the role of any partners and the number of Lions clubs involved in this relief effort?
6. a). Please provide a preliminary budget that indicates the number of beneficiaries to be helped, the type of relief goods to be purchased and the estimated cost. Also explain the distribution plan for these items.
6. b). What type of aid will be provided? (you may select more than one)
first aid supplies
flash lights/lanterns/solar lights
small cooking and eating utensils
6. c). If you selected "other," please describe below.
7. How will the LCIF supported activities be publicized and promoted?
Additional Information: If you have supplemental information on the plan of action, budget, or "other," please upload it here:
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CERTIFICATION BY DISTRICT GOVERNOR
This is to certify that I have reviewed the LCIF Emergency grant criteria. I endorse the need for an Emergency grant and will do everything in my power to assure proper and efficient administration of the Emergency grant funds to purchase and distribute only those immediate needs deemed eligible by LCIF through a Lions-led relief program. The District Governor, in signing this Agreement and any other documents to be delivered in connection herewith may be electronically signed. Please type your name as an electronic signature. A staff member from LCIF will contact you shortly.
In signing below, the District Governor acknowledges that the District will refrain from unlawfully discriminating on the basis of race, color, religion, creed, national origin, ancestry, gender, marital status, age, disability, veteran status or any other legally protected status.
LCIF staff will follow up with the District Governor if further information or clarification is needed. Eligible requests will be presented to the LCIF Chairperson for consideration. The District will be notified by email of the decision.
This online form is new. Currently both the PDF and online version are being offered, please use whichever is more convenient. If you have any suggestions and/or feedback regarding the online form and your experience, please provide it in the space below.
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