Grant Request ApplicationPlease fill out the below form and we will be in touch with you. Date MM DD YYYY ORGANIZATIONAL INFORMATION Legal Name (per IRS Determination Letter) * EIN # * Per the IRS Determination Letter, the organization has been designated as: * Public Charity Government Entity Private Foundation Individual Year Founded * Total Amount Requested * Current Annual Operating Budget * What percentage of your annual operating budget comes from State or Federal grants or other funding? * Executive Director * First Name Last Name Email * Contact person/title (If different from Executive Director) Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Website http:// Mission Statement * Summarize your organization's history and accomplishments: * Outline current programs, activities and services offered: * Current or past programs or projects benefitting youth: * Number of youth served in previous year: PURPOSE OF GRANT Problem/Need: * Identify the need(s) to be met by the project Program/Project Goal: * Target Population Served: * Primary Cities/Counties/States served: * PROGRAM/PROJECT DESIGN Describe staffing, partners, timelines-attach additional page if necessary * ATTACHMENTS FOR GRANT REQUEST All of the below attachments are required to be uploaded. Thank you!
