BRCF GRANT INTEREST FORM

Please complete this form to be eligible for a grant from the Wortman Family Foundation Fund.

Jordan England, Grants & Nonprofit Relations Director, will follow up with the grant contact listed after November 1st. For questions regarding the completion of this form, or the Foundation's grant process, please contact Jordan at 317.392.7955 ext. 101 or jengland@blueriverfoundation.com.

EducationHealthCommunity EnhancementOther

Street Address

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Grant Amount Requested ($2,500 - $25,000):

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