Application
Name Doing Business As
*
Legal Name (as on determination letter)
*
Contact Name
*
Title/Position
*
Contact Phone Number
*
Contact Phone Extension
Contact Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County where office and fiscal management are located
*
County/Counties where services are provided
*
Tax ID#
*
Project Information
Name of the project
*
Proposed date and time of the project
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Date of performance(s)
Project Venue
*
Amount of funding requested
*
Amount of funding requested
Project Description - Please describe your project in a paragraph below.
*
Name of organization’s Executive Director or Head of Administration
Other current and potential sources of funding for the project
*
A list of the current Board of Directors and their affiliations
*
Itemized Project Budget
*
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Copy of the organization's IRS Tax-Exempt Determination Letter
*
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Most recent financial statement and income-and-expense budget for the organization
*
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ONLY Parts I, II and III of the most recent Form 990 submitted to the IRS; the 990 in its entirety is no longer required
*
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How has the pandemic affected your organization?
*
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