2021 Field of Valor Grant Application

Name of Organization *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Website address *

Name of Executive Director

First Name Last Name

Phone Number

Area Code Phone Number

E-mail *

Other Contact Person's Name

First Name Last Name

Phone Number

Area Code Phone Number

E-mail

$ Amount Requested *

GENERAL QUESTIONS

Is organization a 501 c 3 non profit organization? *

Yes No

Federal Tax ID# *

Please list other organizations that financially support your organization *

What veteran, wounded warrior or family needs are the focus of this organization? *

What specific services, equipment or material does the organization provide that meets those needs? *

What communities or geographic area does the organization serve? *

FINANCIAL DATA

Please provide as much information as you can, which will help us determine the amount of your grant.

Gross Organization Revenue in 2020

Gross Organization Revenue to date in 2021

Total Organization Expenses in 2020

Total Organization Expenses to date in 2021

Fundraising Expenditures in 2020

Fundraising Expenditures to date in 2021

General Op. Expenditures in 2020

General Op. Expenditures to date in 2021

Total Organization Payroll in 2020

Total Organization Payroll to date in 2021

# of Employees in 2020

# of Employees in 2021

Compensation of highest paid employee in 2020

Please provide supporting documents for above financial data

INFORMATION ON USE OF FUNDS

Please describe the project's activities and the needs it will meet. Please be as specific as possible. *

How many beneficiaries is this project projected to benefit? *

Expected TOTAL cost of the project *

How much has been pledged or donated to the project to date?

Please list all other organizations or individuals who have made or pledged project donations.

Application submitted by *

First Name Last Name

Signature

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