MUSIC & ARTS ASSISTANCE REQUEST

The Westmont Lions with the support of community businesses have worked together to create a music and arts fund to help qualifying students with their needs in instrument rental, lessons and other areas for support. To qualify, please fill in the required assistance request form, all information must be submitted to validate qualification requirements. Once submitted, a member will review the assistance request and reach out with a determination within 1 to 2 weeks.

WESTMONT LIONS' MUSIC & ARTS ASSISTANCE REQUEST

Please note that all applicants must be 18 to apply.

First name*

Last name*

Address*

Email*

Phone*

Birthday*

Month

Day

Year

Sex*

Male

Female

Marital Status*

Number of Dependents*

Are you currently working?*

YES

If NO, are you DISABLED?*

YES

Student?*

YES

What request are you seeking?*

Instrument Rental Support

Instrument Lessons Support

Arts and Theatre Support

If support request is for Arts & Theatre, please describe the support requested. If no request is for this field, please put N/A.*

Please provide the school staff or organization that provided the need for support request.*

Monthly Income

Total monthly income including wages, pension, unemployment, SSI, SS, food stamps/ebt and other.*

Monthly Expenses

Total monthly expenses including rent or mortgage, utilities, phone, and food. *

Please note that this process may take up to 2 weeks to review and process. All income and expenses must be listed; any blank or incomplete lines will not be processed for review.

Signature*

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The above information is true to the best of my knowledge.

T: 630.969.8080

E: lionsclubwestmont@gmail.com

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