JCL Foundation Grant Application

Jacob and Charlotte Lehrman Foundation GRANT APPLICATION
Contact Information
Full Legal Organization Name
Organization Website
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization President / Executive Director

First NameLast Name
Title
Phone Number
Please enter a valid phone number.
E-Mail Address
example@example.com
Contact Person

First NameLast Name
Title
Phone Number
Please enter a valid phone number.
E-Mail Address
example@example.com

Organization Information
501(c)(3)?

YesNo
Year Established
Federal Tax ID Number:
Fiscal sponsor name
Fiscal sponsor address
Total Organization Budget
Total # of Board Members
Total # of Staff
Total # of Volunteers
Organizational Mission Statement
Brief Description of Organization
Population Served

Proposal Request
Program / Project Name
Total Program Budget
Requested Amount
Percent of Total Budget
Type of Request
Geographic Area Served
Priority funding areas
File Upload - Most Recent Audited Financial Report

Cancelof
Most recent grants received from this funder:
Amount (1)
Date (1)

MonthDayYear
Date
Amount (2)
Date (2)

MonthDayYear
Date

In an effort to expedite approved funding, the Foundation will send grant funds via ACH or wire. Therefore, we kindly request you provide us with both your ACH and wire instructions so we have them readily available if funding is approved for your organization.
Name as it Appears on Account
Name of Bank
ACH Routing Number
ACH Account Number
Wire Routing Number
Wire Account Number
Authorized Representative

Clear
Should be Empty: