Grant Inquiry: $5,000 — $20,000 Please complete this form in its entirety. Incomplete applications will be discarded. Please do not apply for a grant more than once in a ten month period. Purpose of Grant Request Check all that apply. Serving orphans domestically (USA) Serving orphans internationally Serving widows Serving children in foster care domestically (USA) Serving disadvantaged, at-risk children & families domestically (USA) Serving disadvantaged, at-risk children & families internationally Promoting entrepreneurship opportunities & Leadership skills domestically Promoting entrepreneurship opportunities & leadership skills internationally Homeschool legislation or initiative (USA only) Serving Palm Beach County, Florida Organization and Contact InformationOrganization NameTax ID/EINAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website SalutationMr., Mrs., Dr., Rev., etc.Name First Last TitlePhoneFAXEmail Address Provide a brief history of your organizationState the mission and goals of your organizationDescribe your organization's major accomplishments of the last yearWhat are your organization's major goals for the next year?Provide a profile of your organization's key staff and their expertiseList the names, titles, and organizational affiliations of your Board membersHow often does your Board meet?What % of your Board members attend meetings?What % of your Board members donate to your organization?List other donors and their funding levelsProject InformationProgram / Project NameRequested AmountPlease enter a value between 5001 and 20000.Brief state what this purpose is designed to accomplishWhat is the rationale / need addressed by this proposal?What are the objectives of this proposal and approach for reaching the objectives?How will the requested funding help you achieve these objectives?How will you evaluate your success in achieving these goals? Be specific about the measures and indicators you will use to chart your progress.Provide your implementation plan and timetable for completion of the work supported by this grantAdditional InformationIs this the first time you have applied for a grant from the Weisberg Family Foundation? Yes No Have you ever received a grant from the Weisberg Family Foundation? Yes No When did you receive your last grant? MM DD YYYY Amount of Last GrantAdditional File UploadsDocumentation of your 501(c)(3) statusProject DetailsFinancials
