Responses will be issued via email within approximately 60 days of submission.
Organizations may apply once per 12 month period.
Committee will consider your past and present application frequency, data, performance, requests, etc.

Please fill out the form below to request a donation!

NAME OF THE ORGANIZATION

CITY, STATE, ZIP

PHONE

TAX ID NUMBER

STREET ADDRESS

NAME OF CONTACT

WEB ADDRESS

PROPOSAL INFORMATION

What are the main goals of the organization/non-profit?*

How will the funding be used?

Dollar amount requested?

What specific impacts does your organization expect to achieve with this funding?*

What are your primary funding sources?

WHAT ARE THE TOP THREE ACCOMPLISHMENTS OF YOUR ORGANIZATION IN THE PAST YEAR:

Accomplishment 1-

Accomplishment 2-

Accomplishment 3-

Charity Navigator Rating

Percentage of Budget Required for Staff Compensation/Benefits for All Staff

Percentage of Budget Going Towards Programs/Causes

Please attach latest 990 form.

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