Foundation Application Organization's Application for Grant From Private Foundation (Not For Use By Individuals) Step 1 of 4 25% Applicant Name First Last Applicant Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Part 1. Information About The Applicant1. Is the applicant organized as a nonprofit organization under State laws governing charitable organizations Yes No If yes, what State or Commenwealth governs? If no, please explain:2. Has the applicant received a rulling or determination letter from the Internal Revenue Service about any of the following:(a) Except status Yes No (b) Private foundation status Yes No (c) Grant-making procedures Yes No Attach a copy of each such letter.Max. file size: 256 MB.If any item is marked no, please explain:3. Described the applicant's purposes and activities in general:4. Is the applicant controlled by, related to, connected with, or sponsored by another organization? Yes No If yes, give name of organization(s):5. Has the applicant (or any organization listed in 4 above) ever applied for or received a grant from this Foundation? Yes No If yes, give details:Attach a copy of each such letter.Max. file size: 256 MB. Part 2. Use of the propose grant(1) Show the amount requested and explain in detail how it will used. State wheather the grant is to be earmarked for the use or benefit of any one person, group, or class of people. If so, for whom?2. Person to contact who will be administering the program:Print or Type Name First Last Title Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone NumberDescribed this person's experience and qualifications to administer the program: From my own knowledge, I state the information given in PARTS 1 and 2 is correctSignaturePrint or Type Name First Last Title/Office Date MM slash DD slash YYYY The information in Parts 1 and 2 is to help the grantor foundation meet the requirements of Section 4945(h) of the Internal Revenue Code.