Required fields are marked with asterisks (*)

2025 Donation Request Form

Please complete the below 2025 donation request form. We now offer the option to save your work and come back to it later. If at any point you would like to pause your submission, click the save button at the bottom of this form.

Organization Information

Organization Name:

Address (Including Postal Code):

Contact Information

First and Last Name of Contact Person:

Title of Contact Person:

Phone Number:

Alt. Phone:

Email:

Donation Request Information

1. Total Request (Up to $2,500) :

Date of Your Organization's Event:

2. Please provide your reasoning for the requested donation and description of how the funds will be utilized:

Other Financial Information

3. Please indicate financial support you are expecting to receive from other organizations in 2025:

4. If Council approves your Donation Request, please indicate how the Municipality of Port Hope would be given recognition for this donation:

5. Any additional information you find necessary:

Should Council approve your Donation Request please indicate the following:

Special instructions (optional):

First and Last Name of authorized individual:

Please provide the date you are signing this document:

Please provide the signature of the authorized individual:

Clear

Personal information is collected on this form under the authority of the Municipal Act and the Municipal Freedom of Information and Protection Act (MFIPPA). This information, once collected, may be accessible by members of the public upon request, unless exempted by law. Furthermore, this information may be published as part of the public record, in accordance with the legal requirements set out in MFIPPA and other legislation. Questions regarding the collection, use and disclosure of personal in information can be directed to the Municipal Clerk at 905-885-4544 or clerk@porthope.ca.

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