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A copy of the form will be emailed to the address.
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Type of request (check one):
Note: not all funders support each type of request. Check with individual grantmaker.
if checked Project/Program Support
(be specific)
(not required if general operating request)


I certify, to the best of my knowledge, that all information included in this proposal is correct. The tax exempt status of this organization is still in effect. If a grant is awarded to this organization, then the proceeds of that grant will not be distributed or used to benefit any organization or individual supporting or engaged in unlawful activities. In compliance with the USA Patriot Act and other counterterrorism laws, I certify that all funds received from this funder will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes, and executive orders.

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