Alcohol and Other Drugs
Health
Peshtigo Area Foundation
Youth Advisory Council
Community Wide
Women's Giving Circle Grant Application
Women's Giving Circle Grant Application
Accepting July 1, 2016
Today's Date
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Name of Organization
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Organization's Mailing Address
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Contact Person for Project
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Phone
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-
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Cell Phone
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-
Contact's Email Address
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The Organziation is
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a registered 501(c)(3) tax-exempt nonprofit organization
a department of a municipal, county or state government
a hospital, school (public or private), church or department/program thereof
Tell us about your organziation and its purpose
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Project Name
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Is this a new or existing program?
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- Choose One -
New
Existing
Grant Amount Requested (dollar amount only)
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Counties Impacted by Project
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Cities Impacted by Project
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Estimate the number of people that will be impacted by this project
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Project Start Date
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Project End Date
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If a partial grant is received, will this project be completed within the dates listed above?
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-Choose One-
Yes
No
Project Overview/Purpose of Grant
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Total Cost of Project (dollar amount only)
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List Project Expenses
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List Project Income Sources
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List grants your organization has received in 2015 & 2016 from all sources
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Attachment Requirements: Most recent IRS Form 990 (pgs 1&2) If not applicable attach IRS Letter of Determination
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