Grant Request
Name
Email
Telephone
A short paragraph that states
:
a.Who you are.
b.How much you’re asking for.
c.What you intend to do with the grant.
d.How may we contact you?
e.Who to make the check out to?
Is your organization non profit?
No
Yes
Only if
YES
, please fill out the following.
Your fiscal agent / sponsor
Telephone for fiscal agent / sponsor
Please include a copy of your Internal Revenue Service Letter of Determination of 501(c)3 Non-Profit Status.
PDF Only Please
.PDF file only, please!
Reason for requesting a grant:
i.e.: startup costs, equipment not covered by normal operating budget, program incentives, direct service cost and scholarships.
Enter this word into
the field below:
Senders IP Address: 38.107.179.210
