Grant Application

First Name

Last Name

Phone

Name of organization

Your title within the organization

Title for this grant

Grant amount requested

Total of amount requested for this project/program

Total organizational annual budget

Population(s) served? What region(s)?

Please provide specific uses of the requested grant

Please list your board of directors

Tipping

Please determine that your grant request will not "tip" your organization from being publicly supported. You may need a tax advisor for this determination.

Please attach the appropriate documents.

Budget for the project/program

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Financial Information

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IRS determination letter

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Supplemental Document (Optional)

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