Grant Application Cover Sheet Community Foundation

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Grant Application Cover Sheet
Legal Name of Organization
(as listed on IRS 501(c) 3 Letter):
Federal Tax ID Number:
Organization Address:
Website:
Fax:
Executive Director:
Phone:
Email:
Project Director:
Phone:
Email:
Project Title:
Project Start Date:
Project End Date:
Amount Requested:
Total Budget Amount:
Other Identified Funding Sources:
Organization Profile
Year Founded:
# of Employees:
Mission Statement:
Total Annual Operating Budget: $
Service Area Zip Codes:
% of Clients in West Chester/Liberty:
Total Number Served:
Age Group Served:
Authorization Signature:
If approved, this agency agrees to carry-out the project as approved by The Community Foundation
of West Chester/Liberty.
Name:_______________________________________Date:____________
Title: _________________________________________________________

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