Your Name*

Your Email*

Legal Name of Organization:*

Mailing Address of Organization:*

Executive Director/President or CEO Name, Title, and Phone:*

Executive Director Email Address:

Brief Statement introducing your organization:

List the organizations you have applied to for funding and any amounts they have committed:

Briefly explain the issue you hope to address by requesting this grant and the time frame that the request covers:

Describe the outcomes you hope to achieve with this grant, including your plan to evaluate the success of this project:

Explain how you will use the funds, and in the event your full request cannot be met, indicate priority items in the proposed grant budget:

Attach (in pdf form) your organization's operating budget and financial statement which should include a profit and loss statement and a balance sheet, and what percent of agency income is designated for administrative costs:

Attach (in pdf form) your organization's 501c3 status designation letter:

Check the box to verify that this application is for an organization located in the Greater Grand Rapids, Michigan area of the United States of America.*The Foundation accepts applications only for organizations located in the Greater Grand Rapids Michigan area of the United States of America. The form will not send unless you can verify your organization is located in the Grand Rapids Michigan area.