Please
fill in the Grant application and then click
on Submit
Applicant's Name:
Name of Organization
Requesting Funds:
Purpose of
Organization:
Who authorized
this application?
Name of Chief
Operating Officer:
Contact Name:
Address:
City:
State:
Zip:
Email address:
Phone:
Fax#
TIN#
*
Amount Requested
$
Date of Request:
(mm/dd/yy)
Do you have
bookkeeping capability?
Yes
No
Will these
grant funds benefit our local community?
Yes
No
Can you make
a report/presentation to our Club's Board?
Yes
No
Type of Organization
IRS Designated
501(c)3
IRS Designated
501(c)4
IRS Designated
501(6)
IRS Designated
501(c)19
Faith Based
Organization **
Not for Profit
Corporation, please include: ***
State of Organization:
Cert.#
Unincorporated
Association
Purpose of Requested
Funds:
* TIN number will
be validated using the IRS publicly available
database.
** Faith based organizations must be conducting
projects that benefit the community as a whole.
Grants cannot solely or primarily benefit, directly
or indirectly, their adherents or members.
*** If qualified not-for-profit, you must attach
certification from IRS.
