The Whitingham-Halifax Lions help many needs and activities, as determined by our board of directors and available budget. 

Two that we regularly fund are our Community Service Awards (scholarships for local seniors) and eyeglass assistance for those who cannot afford prescription eyeglasses in our community.  

We are known to fund other worthy activities that further the environment, vision & hearing, diabetes awareness, juvenile cancer, hunger relief,  education and the betterment of our community.  

In order to start the ball rolling, we ask that you copy form #1 or #2 listed below, fill it out completely, and return it to those listed or to any of our officers, whose contact information is found on our Contact Us page. 

You can also contribute to your Lions club by filling out form #3 below.


1. Whitingham-Halifax Lions Application for Assistance with Eyeglasses

Please complete this form and mail it to:

Whitingham-Halifax Lions, PO Box 367, Jacksonville, VT  05342

Name of person requesting eyeglasses (and support person / organization as needed)


Phone ____________________________                          

Address ________________________________________________________________________

Eyeglasses provided thru the Luxottica Gift of Sight Foundation require that we screen applicants for financial need. Please outline the amount and sources of income and reason you need this assistance in the space below.




How did you hear about of this program? ___________________________________________

Signed  __________________________________________________Date__________________  

Note: We mainly rely on what you tell us. By signing the application you authorize verification of your need.  Applicants will be notified by Mail and Phone of decision.

2. Whitingham-Halifax Lions General Request for Funds

Please complete this form and email it to and 

Or mail it to Lions, PO Box 367, Jacksonville, VT 05342

DATE OF APPLICATION:  _____/_____/_________


Person:   ____________________________    Organization:   ____________________________

Address:    ____________________________ City, State, Zip: ____________________________


What is the full amount necessary for your program (if applicable)?  $_____________

How else are you fundraising (fundraising events, requests to other organizations, etc.)?:




Do you wish to present your request at a regularly scheduled Lions meeting (generally 1st & 3rd Monday):  ____ Yes  /   ____ No

Please explain the purpose, date or date range, location and reason(s) for your request.




Do you have any written documentation or information? If so, please include with your request. Be as specific as possible. Note: Funding amounts fall into our guidelines so that all beneficiaries are treated equally; as such we may not fund to the level requested.  

We meet two times per month (fall, winter, and spring) and will process your request as quickly and efficiently as possible, but please allow one full month for a decision. (Summer applicants may wait until fall due to our schedule.)


3. Your Donation of Funds or Gifts to the Whitingham-Halifax Lions 

We welcome funds and gifts to help the Lions mission of serving others.

Please print this form and email it to, or mail it to:

Whitingham-Halifax Lions, PO Box 367, Jacksonville, VT  05342

DATE :  _____/_____/_________


Person:   ____________________________    Organization:   ____________________________

Address:    ___________________________   City, State, Zip: ____________________________

Phone:       _____________________                     Email: ________________________________

I/We would like to contribute specifically to (name of Lions event or cause):___________________

I/We would like to contribute to the Lions public activity (charity) fund, amount: $_______________

Or, list the kind of donation you will be making (goods, services, etc.):_______________________

Make monetary donations payable to "Whitingham-Halifax Lions" and note any specific cause in the Memo line of your check.  Thank you!

Note that unused eyeglass may be donated at convenient locations in the Deerfield Valley or around Vermont.  Click this link or more information on Lions Eyeglass Recycling.  

Thank you for thinking of the Lions. 

We strive to help as many people as we can in the community.


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