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Grant Application
This form is to be filled out by all organizations looking to receive grant money from The Jeremy Ziegler Foundation. Please complete and submit this form with all required information, as well as any additional information you feel would aid us in the desision making process.
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* Indicates required question
Date of application:
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Your answer
Legal name of organization:
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Your answer
Organization mission:
Your answer
Are you a non-profit organization currently in good standing with the IRS?
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Yes
No
Year founded:
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Your answer
Executive Director:
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Your answer
Contact person:
(If different from the Executive Director)
Your answer
Phone number:
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Your answer
Email:
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Your answer
Website:
Your answer
Project name:
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Your answer
Purpose:
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Your answer
Total project cost:
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Your answer
Amount requested:
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Your answer
If the amount you are seeking from The Jeremy Ziegler Foundation is not the total amount required for this project, what other sources of funds will be used for this project?
Your answer
Project goals:
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Your answer
How will this grant assist you in reaching these goals?
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Your answer
Is there any additional information you would like to provide?
Your answer
I confirm that this information is accurate to the best of my knowledge and that if selected for a grant I can provide additional documentation requested including, but not limited to, a copy of this organizations's IRS determination letter and any bids specific to this project.
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