Grant, Loan & Gift Program

Name of Applicant/Organization: ______________________________________

Tax Status of Applicant: ______________________________________________

Tax Exempt No: ____________________________________________________

Name of Contact Person: _____________________________________________

Address: ________________________________________________ Zip ______

Phone Number: _____________________________________________________

Fax Number: _______________________________________________________

Email & URL: _____________________________________________________

Total Amount Requested (Schedule attached [ ]): __________________________

Check off all the categories that may apply to your Application for Aid

[ ] 1. religious activities

[ ] 2. charitable activities

[ ] 3. scientific research activities

[ ] 4. literary activities

[ ] 5. to support the Ministry

[ ] 6. to make [ ] grants, [ ] loans or [ ] gifts

Attach Proposal -- please check off all items that are included:

(1) [ ] Summary of Proposal
(2) [ ] Background of Applicant
(3) [ ] Statement of Need
(4) [ ] Goals, Concepts and Implementation
(5) [ ] Conclusion
(6) [ ] Key Person Biographies or Resumes
(7) [ ] Sample Information and Program Outlines
(8) [ ] Schedule of Funds Requested and Financial Information.

Date of Application: ________________

_________________________

Name: ___________________