Alpha Delta Zeta Women's Society Incorporated

Alpha Delta Zeta Women's Society

Butterfly Sister Fund Application

Select every type of assistance that applies to your situation. Requests are reviewed confidentially, fairly, and on a case-by-case basis.

Full name

Email address

Phone number

Member ID, if assigned

I confirm that I am a current Alpha Delta Zeta Women's Society member in good standing.

What type of assistance are you requesting? Please check all that apply.

Short-Term Dues AssistanceMay provide assistance with up to one (1) month of membership dues.Temporary Financial Hardship AssistanceMay provide assistance with up to two (2) months of membership dues for members experiencing a temporary financial hardship.Emergency AssistanceMay provide limited emergency financial assistance for unexpected hardships, subject to available funds and committee approval.Other Temporary AssistancePlease describe your need below. Requests are reviewed case by case and are subject to available funds.

Amount requested

Date assistance is needed

Briefly describe the temporary hardship and how assistance would help

Are you able to contribute a partial payment?

YesNoNot at this time

Have you already received Butterfly Sister Fund assistance during your current membership year?

NoYesI am not sure

I understand that Butterfly Sister Fund assistance may be approved only once per membership year. Assistance is confidential and temporary, is not guaranteed, and is subject to eligibility requirements, available funding, and Butterfly Sister Fund Committee approval. I understand that the Fund does not cover application fees or the first month's dues required when initially applying for membership.

Electronic signature

Date submitted

Fields marked with * are required. Your information will be used only to review and respond to this request.

The Butterfly Sister Fund.

Butterfly Sister Fund Application