Request Form – Lactalis Canada Connect

Lactalis Canada Community Enrichment Fund
Request Form

Insert Disclaimers and Waivers here

Select a Site *

Applicant Name

Position

Phone

Email Address

Organization's Name

Charity Number

Street Address

Apartment, suite, etc

City

Province

Postal Code

Organization's Phone Number

Organization's Director Name

Organization's Mandate and Goals

Organization's Website

Organization's Social Media Handle

Upload Your Organization's Logo

Drag and Drop (or) Choose Files

Amount of Request

CAD

Date Required

Project or Activity

Key Beneficiaries or Activity

Marketing or Social Media Plan

Recognition for Donors

Organization's Phone Number

Organization's Email Address