Your Organization Details
Name of Organization
Date Organization Founded: mm/dd/yyyy

501 (c)(3) name:

501 (c)(3) number:
501 (c)(3) recieved: mm/dd/yyyy
Annual operating budget:
Name of InterLinc employee referral
What opportunities are there for InterLinc employees to volunteer?
Is there anything urgent in nature about this submission that requires immediate attention?
 

Your Contact Information
Organization Director/CEO:
Title:
Contact person:
Phone number:
Email address:
Confirm email:
Street address:
City:
State:
Zip:

Project Specifics
Title of proposed project:
Total project cost: approximate amount
Total project funding secured to date from all sources: approximate amount
Portion of project cost to be raised from private
sources: approximate amount
Total project funding secured to date from
private sources: approximate amount
Proposed grant request:

Organization/Project Details
Please briefly state your organization's mission, date of last application, and a description of your organization:
Please state concisely the project/purpose for which the proposed grant is sought:




 

 


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