Kitty M. Perkins Foundation Grant Application

304 Nelson St.

Cambridge, NE 69022

www.kmpfoundation.org

GRANT APPLICATION

APPLICANT: _______________________________     Federal ID#___________________

                    (Name of Organization as registered with IRS)

ADDRESS:________________________________________________________________

                          (Street)                (City)                      (State)                         (Zip Code)

EXECUTIVE CONTACT:______________________________________________________

                                            (Name)                                      (Title)            (Phone Number)

PRINCIPAL PURPOSE OF ORGANIZATION:

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PROPOSED USE OF FUNDS APPLIED FOR (Be Specific):_________________________

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TOTAL COST OF PROJECT                                          $____________________________

FUNDS AVAILABLE AND/OR PLEDGES RECEIVED   $____________________________

AMOUNT OF THIS REQUEST                                        $____________________________

BALANCE REQUIRED TO TOTALLY FUND PROJECT $___________________________

ANTICIPATED SOURCE OF BALANCE REQUIRED TO COMPLETE PROJECT: 

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AMOUNT OF LOCAL OR ORGANIZATIONAL SUPPORT:

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HOW DOES THIS REQUEST ADVANCE THE MISSION OF THIS FOUNDATION AS STATED IN THE “POLICIES OF THE FOUNDATION”?

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                            _________________________________________________

                                    (Name of Applicant)

                            BY:______________________________________________

                            TITLE:____________________________________________

                            DATE:____________________________________________