Grant Application - Hansen Family Foundation

Are you a 501(c)(3) non-profit organization?*

Organization

Organization Name*

Tax ID Number*

Address*

Street Address Address Line 2 City State ZIP Code

Contact Person

First Last

Title*

Phone*

Email*

Website

Organization biographical narrative (origin, history, board composition, staffing, volunteer involvement, mission, major accomplishments, etc):*

What specific services or products are provided? Give examples.*

How are services or products delivered?*

What areas are serviced by the organization (geographic, demographic, etc)?*

Annual Budget:*

% of funds used for overhead costs:*

% of funds used to directly provide services or products:*

Funding Sources*

Grant amount requested from the Hansen Family Foundation?*

For what specific purpose(s) will the grant be used?*

If this grant will be used for a specific project, how will the grant money be distributed?

% of project total:*

% to overhead costs:*

% to delivery of direct services or products*

Will grant money will be used for building construction or improvements:*

% to building construction or improvements:*

% to overhead costs:*

Describe your fundraising plan.*

Provide copies of any competitive bids.

Drop files here or

Provide property insurance information.

Coverage Amount

Insurance Company

If your organization previously received grant money from the Hansen Family Foundation, how were those funds used?

Additional Comments

Name

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