1. Full LEGAL name of the organization (This is the name as it appears on your Articles of Incorporation):
   
2. Mailing Address:
   City:   State:   Zip:
3. Telephone: Fax:
4. Date of Application: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , 20
5. Name and phone number of individual to be contacted regarding this grant application:

   Name:
   Title:
   Telephone:
   E-mail:

6. Name of grant project:
7. Amount of grant funds requested: $ , .
8. Employer Identification Number: -
9. Attach as Exhibit "A" a copy of the organization's most recent IRS Determination Letter showing 501(c)(3) tax-exempt status.
10. Attach as Exhibit "B" a copy of the organization's most recent tax return and/or audited financial statements.
11. Attach as Exhibit "C" copies of the following current documents:  
    A) Articles of Incorporation  
    B) Bylaws  
    C) List of current Board of Directors and Officers, to include addresses and phone numbers.
12. Attach as Exhibit "D" a brief history of the organization to include past programs and projects, number of persons served or affected by activities, and future goals of the organization.
13. Attach as Exhibit "E" a description of the project or activity for which grant funds are being requested. This description should include the purpose and the goals to be achieved.
14. Describe any relationships, business or personal, that exist between any officers or directors of your organization and any officers or directors of the Ed Rachal Foundation. Our Board of Directors are listed here.
    (210 characters maximum)
    
15. List the dates and amounts of any previous grants your organization has received from the Ed Rachal Foundation. (210 characters maximum)
    
16. List the names, addresses and phone numbers of any other donor organizations you expect to receive funds from for this project. List requests that may still be pending. Attach additional pages if needed. (500 characters maximum on form)
    
17. Date of your last grant request to the Ed Rachal Foundation:
    Never Requested January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , 20
18. If your grant request is approved, will you execute and abide by the terms of our grant agreement form?
    Yes, I agree to abide by the terms of the grant agreement form.
19. I, , of the have reviewed this application and believe it to be true, correct and complete. I further represent that the governing body of the organization authorizes the making of this request.

Directions: This page exists to enter your information only. After clicking on the "Finished" button below you will see the application form in the format we need. Review the information for correctness. When this is done, go to the File Menu above and select Print. There will be a signature line printed out for you to sign. Please sign and date where indicated and mail with the required documents.