LETTER OF INTENT TO SEEK FUNDING

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Date of Application: _________________

Legal name of organization applying: _____________________________________________________

(Should be same as on IRS determination letter and as supplied on IRS Form 990.)

Organization and Contact Information

Year Founded: _____________________Current Operating Budget: ______________________

Executive Director: _______________________________ Phone number__________________

Contact person/title/phone number (if different from executive director):

______________________________________________________________________________

Address (principal/administrative office): ____________________________________________

City/State/Zip: __________________________________________________________________

Fax Number: ________________________ E-mail Address:_____________________________

List any previous support from this funder in the last 5 years: ____________________________

______________________________________________________________________________

Proposed Project Information

Project Name:______________________________________________________________________

Purpose of Grant (one paragraph):

_________________________________________________________________________________

Dates of the Project:_________________________________________________________

Amount Requested: $______________________

Total Project Cost: $______________________

Geographic Area(s) Served:_________________________________________________________

_____________________________________	____________________________________
*Signature, Chairperson, Board of Directors*	*Signature, Executive Director*
____________________________________	____________________________________
*Typed Name and Title*	*Typed Name and Title*
__________________	__________________
*Date*	*Date*