Grant Inquiry: Over $20,000 Please complete this form in its entirety. Incomplete applications will be discarded. Please do not apply for a grant more than once in a ten month period. Purpose of Grant Request Check all that apply. Serving orphans domestically (USA) Serving orphans internationally Serving widows Serving children in foster care domestically (USA) Serving disadvantaged, at-risk children & families domestically (USA) Serving disadvantaged, at-risk children & families internationally Promoting entrepreneurship opportunities & Leadership skills domestically Promoting entrepreneurship opportunities & leadership skills internationally Homeschool legislation or initiative (USA only) Serving Palm Beach County, Florida Organization and Contact InformationOrganization NameTax ID/EINAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website SalutationMr., Mrs., Dr., Rev., etc.Name First Last TitlePhoneFAXEmail Address Organization-Related Financial InformationUpload your organization's current operating budgetTotal number of staff% of administrative costs assigned to operating budgetDoes your organization use an outside fund-raiser? Yes No How much was spent in the last year?If the fee is a % of the gross amount raised, what % is retained by the fund-raiser?Summary: Operating BudgetGrant Request (Initial Year) - ($)All Other Revenue Sources ($)Total Operating Budget ($)Grant Request (Initial Year) - (%)All Other Revenue Sources (%)Special Project, Request, or Initiative-Related Financial InformationUpload project budgetTotal number of full-time staff equivalents assigned to this projectList other grants received or committed for this project (Grantor - Amount)Summary: Special Project, Request, or Initiative BudgetGrant Request (Initial Year) - ($)All Other Revenue Sources (For this Project Only) - ($)Total Special Project, Request, or Initiative Budget ($)Grant Request (Initial Year - Target < 30%) - (%)All Other Revenue Sources (For this Project Only) - (%)Additional 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
