Step 1 of 2

COMMON GRANT APPLICATION COVER SHEET

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Address*
(Attach a copy of the IRS Letter of Determination- NOTE- this is not the state sales and use tax exemption certificate. If there has been a name change provide copies of the amended state certificate of incorporation and amended IRS Letter of Determination.)
Max. file size: 128 MB.
(Attach a copy of the written agreement from fiscal agent plus fiscal agent’s contact information and EIN.)
Max. file size: 128 MB.
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)

Agreement

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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