Application Form Name of the requesting organization * Name of the requestor * First Name Last Name Phone number of the requestor * (###) ### #### Email address of the requestor * Organizational role of the requestor * I, the requestor, am legally qualified to submit this application on behalf of my organization * Yes, I am qualified List any other organizational contacts who should be included 501(c)(3) Employer Identification Number (EIN) of the organization * If awarded, what is the organization address for the check to be made out and mailed to * Checks will only be made out to organizations, not individuals Organization website URL (if applicable) * Organizational history and mission * (Please include year founded and whom or what the organization serves and supports in less than 300 words) If awarded a grant, how is the requested funding intended to be used? * Amount of grant funding you are requesting * Thank you for submitting your grant request. You can expect to hear back from us within the next 3 - 4 weeks.
