Date *

MM

DD

YYYY

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Physical Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Contact Name *

First Name

Last Name

Did you receive a grant from us in 2025? *

Yes

No

Was the entire grant amount used for the intended purpose? *

Enter "N/A" if you did not previously apply for a grant.

Yes

No

N/A

Are receipts, invoices, bids, etc, attached to verify that year's use of the funds? *

Yes

No

N/A

Date Signed

MM

DD

YYYY

Required Documents Check List *

Check the box next to each document you have included in your attachment.

IRS Determination Letter

Most Recent 990 Tax Return (Jan-Dec, 2025)

Monthly (12) and Annual (1) Income and Expense Reports (Jan-Dec, 2025)

Most recent Annual Profit and Loss Statement (Jan-Dec, 2025)

Proof that Previous monies were spent on requested purposes, if applicable (i.e. Receipts, invoices, purchase order)

Budget for any complex projects or undertaking (if applicable)