Grantee Application Form

Date of Application *

Legal Name of Non-Profit *

Funding Pillars *

Contact First Name *

Contact Last Name *

Phone *

Email *

Mailing Address *

City *

State *

Zip *

Physical Address *

City *

State *

Zip *

EIN # *

Year Founded *

Website *

Key Leadership Team - Name, Role *

Mission Statement *

Please limit to one paragraph

Grant Project Name *

Grant Request Amount *

Restricted Grant Purpose *

Please limit to three sentences

2025 Operating Budget *

Primary Source of Funds *

IRS Determination Letter *

Max file size is 10MB.

Please upload a file before submitting.

Most Recent IRS Form 990 *

Max file size is 10MB.

Please upload a file before submitting.

Conflict of Interest Policy *

Max file size is 10MB.

Please upload a file before submitting.

Board List, Noting Affiliation *

Max file size is 10MB.

Please upload a file before submitting.