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Grant Application – Susan Cox Powell Foundation
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Name
This field is for validation purposes and should be left unchanged.
Organization Information
Please fill the form and give us more information about your organization.
Organization Name
(Required)
Tax ID/EIN
(Required)
Website Address
(Required)
Contact
Information
Salutation
Ms.
Mr.
Mrs.
First Name
Last Name
Contact Title
Address
City
State
Zip Code
Phone Number
Fax Number
Email Address
Additional Notes
Project
Description
Project Name
Project focus
(Required)
Educational/vocational training
Services to at-risk youth
Services to children with disabilities
Services to the elderly
Health-related issues
Services to children and families from disadvantaged backgrounds
Please give a brief description of the grant purpose
Please give a full description of the purpose of this grant (specific need to be met):
Additional Notes or Comments
Budget
Information
Amount of this grant request
Total budget for this project
Total annual organization budget
Additional Notes or Comments
Organization
Information
Organization’s Purpose
Organization’s Operation
Organization’s History
Additional Notes or Comments
Board of
Directors
Organization’s Purpose
Any other information you believe the Board would find relevant
Certification
Name
Title
Date
