Contact Us

Jack Lisi Youth Award, Inc.
PO Box 321
Bath, N.Y. 14810
Phone: 607-776-9467 Ext. 229
Find us on Facebook @jacklisiyouthaward

Current Year 
Award Recipient Information

Below you will find the "Award Disbursement Request Form." 

This form will need to be completed in order to utilize your award disbursement. If you have any questions or concerns, please email 


You can submit the form in the following ways: 

  1. Utilize the fillable form and email to 
  2. Print the form and mail to: PO Box 321, Bath, NY 14810
  3. Print the form and fax to: 607.776.9482

General Information,
May 12, 2020, 4:14 AM
General Information,
May 18, 2020, 7:02 AM