Organizational Information

Name of Organization *

Address of Administrative offices *

Address Line 1

Address Line 2

City

State

Zip Code

Main Office Phone *

Current issue 501(c)(3)

Brief Overview of Organization and Mission *

Current Operational Budget of Organization in Dollars *

Main Contact Information

Main Contact Name *

First

Last

This is you, or the person you wish to exclusively receive correspondence regarding this proposal.

Main Contact Email *

Main Contact Phone *

Project Type *

Foundation Funding Area *

Proposed Project Name *

Grant amount requested *

Ideal timing of awarded Grant payment is on or before: *

Definition of the issue addressed by proposal *

Description of the need for proposed project *

Objectives of the proposed project and its potential impact *

Description of expected outcomes & impact including description of persons or groups who will benefit *

Evaluation plan including criteria for judging effectiveness of proposal *

Project Budget & anticipated support from others *