Harvest Open – 2015 Application

This application is for internal use by the Lonza Harvest Open Committee in determining beneficiaries of its charity golf tournament to be held in September. The selection process begins in March with recipients chosen in April. There is a three-year waiting period before previous beneficiaries can re-apply. Deadline for submission is Friday February 27, 2015. If selected as a beneficiary, the organization agrees to attend as needed meetings at a Lonza designated location from May through September as well as perform various other duties to ensure a successful event. The minimum required duties of the organization includes obtaining raffle prizes for the day of the event, providing volunteers to support activities at each course during the event and writing thank you letters to sponsors immediately following the event. By submitting an application, your organization agrees to these minimum requirements.

Please email a completed application with attachments to or mail to the attention of: Heather Palmer at Harvest Open, Lonza Biologics Inc, 101 International Drive, Portsmouth, NH 03801.

Program Focus (circle) Youth/Education Health/Social Services Civic/Cultural Environment
Organization / Date of Application:
Address
City/State/Zip
Phone # Fax # / Lonza Contact/Referral:
Contact Persons Name, Title, Email, Phone:
Volunteers available to help on Tournament Day: Yes No
Fiscal Year End (month/date, e.g. 12/31)
2014 / 2015 / 2016 Projected
Total Agency Budget / $ / $ / $
Program/Project Budget (provide details below) / $ / $ / $
Net Assets / $ / $ / $
Revenue Distribution / 2014 / 2015 / 2016 Projected
Government Contracts / % / % / %
United Way / % / % / %
Corporate/Foundation Grants / % / % / %
Other (Fees, Individuals, etc.) / % / % / %
TOTAL / 100% / 100% / 100%
§  Summarize your agency’s mission and programs and specifically note how these funds will be used. Quantify how being a beneficiary will impact your organization and those you serve (attach additional page(s) if needed).
§  Attach additional material relevant only to this request including a copy of your or your parent organizations 501(c)3 status, board and/or advisory board member list, annual operating budget, etc.