Grant Application Form Page 4
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7Ronald McDonald House Charities New York Tri-State Area, Inc.
G
A
F
RANT
PPLICATION
ORM
Page One
NEW YORK
TRI-STATE AREA
A.
Legal Name of Organization
______________________________________________
{As it appears on your 501(c)(3)}
Employer ID Number (EIN)
______________________________________________
B.
Project Title
_______________________________________________
Which of the following best describes the disposition of your project? (Please check one)
Medical/Health Care
Educational
Arts & Entertainment
Civic/Social Services
Crisis Intervention
Other:______________
C.
Please summarize your project in one sentence: ____________________________________
___________________________________________________________________________________
D.
Primary Contact Person:
(Mr. / Ms.)_______________________________________
E.
Mailing Address
________________________________________________
________________________________________________
City/State/Zip
________________________________________________
County
________________________________________________
Phone (including area code) _____________________________________________
Email Address
________________________________________________
F.
Specific amount requested from RMHC $________________________________________
Please include an itemized Project Budget in your application. The Project Budget must specify precisely
how the requested funds would be used.
Invoices and work estimates are welcome, and may help to
describe your specific needs.
G.
McDONALD’S ENDORSEMENT (if applicable)
McDONALD’S CONTACT
_______________________________________
TITLE/POSITION
_______________________________________
ADDRESS
_______________________________________
_______________________________________
Telephone (including area code)
_______________________________________
To what extent have you worked with the McDonald’s contact?
Revised 07/2012
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