FUNDING REQUEST FORM
For tax purposes we require that the application be completed in its
entirety prior to authorizing a donation.
Fields marked with an * are required.
As a recipient of a 2016 charitable contribution, please provide the following
information about the individuals serviced by this event.
NOTE: Each section below is mandatory to fill. If program specific data is not available, please provide demographic
information for the clients served by your agency. Each section should total 100%. Please use the 'Unknown' box if data is not available in order to make it 100%.
*Number of people anticipated to be served in your program/agency in 2016