BRCF GRANT INTEREST FORM

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Please complete and submit the following online grant interest form to be eligible for a grant from Blue River Community Foundation.

Jordan England, Grants & Nonprofit Relations Director, will follow up with the grant contact listed. 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.

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Organization Name:

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Organization Mailing Address:

Street Address

Street Address Line 2

City

State

Zip Code

Country

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Organization Phone:

Area Code

Phone Number

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Organization Website Address:

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Organization's Executive Director/Authorizing Official:

First Name

Last Name

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Grant Contact:

First Name

Last Name

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Grant Contact's Title or Relationship to Organization:

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Grant Contact's Phone:

Area Code

Phone Number

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Grant Contact's Email:

example@example.com

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Is your organization classified as a designated 501(c)3 with the IRS?

YESNO

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Will this program serve Shelby County residents?

YESNO

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Grant Amount Requested:

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Provide a Brief Summary of Your Grant Request.Provide a description of the charitable nature of your project/program. Please include information about the organization that will serve as the Fiscal Sponsor, if applicable. *maximum word count 250

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