Patronage Request Form

Guidelines for granting vice-regal patronage are governed by the instructions adopted by the Department of Canadian Heritage for Lieutenant Governors across the country. The Lieutenant Governor's patronage cannot be associated in direct connection with fundraising campaigns or fundraising events.

Organizations who wish to request the continued support from the incoming Lieutenant Governor must re-apply.

The Lieutenant Governor does not normally accept new honorary patronages requests during the final year of their term in office.

Organizational Criteria

a) The organization must normally be one that is provincial or regional in scope;
b) It should have been existence for at least (5) years (exceptions may be made);
c) It must have active programs;
d) It must have programs which are of direct benefit to the community at large;
e) It must be solvent;
f) Agree not to use the Lieutenant Governor’s patronage in direct connection with fundraising campaigns or events;
g) Organization must be a non - profit.

Term of Patronage

Honorary patronage is only granted by the current Lieutenant Governor. All patronages expire with the term of the Lieutenant Governor.

Organizations must re - apply to seek the patronage of a new Lieutenant Governor.

Name of Organization: *

Mailing Address: *

National/International Affiliation:

If applicable.

Website Address:

Contact

Contact information for your organization’s President/Chairperson/Director.

Name: *

Title:

Phone Number: *

(

Area code

)

First three digits

Last three digits

Alt Phone Number:

(

Area code

)

First three digits

Last three digits

Fax:

(

Area code

)

First three digits

Last three digits

Email: *

Alt Contact

Name:

Title:

Phone Number:

(

Area code

)

First three digits

Last three digits

Fax:

(

Area code

)

First three digits

Last three digits

Email:

Canada Customs and Revenue Agency Business / Registration No: *

Year organization was founded: *

Size of your organization

No. of Paid Employees:

No. of General Members:

No. of Board/Committee Members:

Past Lieutenant Governors:

Please list any former Lieutenant Governors who have previously offered their patronage to your organization (please indicate years of patronage if known)

Past Honorary Patrons:

Please list any other Honorary Patrons that your organization may have (include provincial, national and international)

Mission Statement: *

Your organization’s Mission Statement.

Activities:

Please describe of the scope of your organization’s activities including local, provincial and national if applicable. Please include information on your aim, achievements and awards if any.

History: *

Please provide a brief history of your organization.

Leave this field blank