Community Grant Information Form

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Please fill out this form and submit.

Name of Organization*
Address*
Street Address Address Line 2 City State ZIP Code
Contact Name*
First Last
Email*
Phone*
Fax
Title or Topic of Grant*
Amount Requested
Total Cost of Project
Does your organization have tax-exempt status under the internal revenue code?
- Yes
- No
Please submit a letter affirming 501 (c) 3 status
Mission Statement of the Organization
Comments
This field is for validation purposes and should be left unchanged.