Member Form
Please start your Grant Application by filling out this Member Form. When this is completed, your Agency Contact will be emailed the Agency Form.
Grant Title
*
Grant Start Year
*
MBTF Sponsor Name
*
First Name
Last Name
MBTF Sponsor Email Address
*
example@example.com
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Agency Requesting Grant
Agency Name
*
Name of Contact Person
*
First Name
Last Name
Agency Contact Email
*
example@example.com
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Funding
Total amount requested
*
Payable in (year):
*
Payable in:
*
Payable in:
*
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Directions
Funds to be directed to:
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First Name
Last Name
Funds will match agency fundraising efforts:
*
Yes
No
If yes, please specify Agency:MBTF ratio.
*
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Disclosure & Certification
My relationship with this organization is:
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Signature
*
Certification
*
I acknowledge that the above requested grant does not represent the payment of any personal pledge or other financial obligation, nor do I expect any personal benefit from this grant, including membership in a group, tickets, or invitations to events.
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Grant Information
Amount requested
*
Describe the grant in one sentence
*
Please highlight the impact of this grant in your own words.
*
Points to cover might include: what do you see as the strengths of this agency; what are the priority criteria in this project (such as high level of member involvement, stimulating matching funding, seed money for expansion, start-up costs, etc.) One paragraph should be sufficient.
Has this agency been sponsored by the Foundation in the past? If so, assess the past grant’s effectiveness. How does the current grant differ from past grant(s)?
*
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Personal involvement
What is your personal involvement with this agency?
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Have you contributed money and/or time to this agency?
*
Of your philanthropic interests, how does this project or agency rank?
*
Do you expect to come back with further requests for this agency?
*
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