Grant Request Form.

Please provide evidence of your current 501(c)(3) certification and a current IRS Form W9.

PO Box 3755
Abilene, TX 79604-3755

Request Date

YYYY

Organization Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Name

First Name

Last Name

Title

Phone

(###)

###

####

Mission and Description of your Organization:

Description/Purpose of Project:

How this benefits the local community:

Proposed use of funds. Include estimated cost of budget:

Amount Requested from Foundation: