ABOUT THE APPLYING ORGANIZATION
1. Organization Name
                      Address
                        Phone:
 Contact Person:

2. What is the amount of money requested from the Hardin county Community Foundation?
      

3. Does your organization have tax exempt status under the provisions of the U.S. Internal Revenue Service or claim same through an affiliate organization? Yes No
If so, please provide ID number:

4. Has your board or governing body authorized this request? Yes No

5. Please list any other sources of funding requested or received for this project.


ABOUT THE PROJECT

1. Describe the project giving its purpose, who will benefit from the project, how the project will be carried out and why it needs to be done.  Give planned project start/complete dates.

Who will submit the written report to the Foundation within 30 days of the completion date or one year from the date the funds were received?
NAME ADDRESS
PHONE
If the funds are not used within one year, they are subject to be returned to the Foundation.  Failure to file this report could result in your not receiving funds in the future.

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