CBV Cares Grant Request

FUND GRANT REQUEST

SPONSOR AGENT NAME:   

AMOUNT REQUESTED:  $100  $250  $500  $1500

(If wanting to request above $500, the Sponsor must attend review meeting and give presentation.)

DO YOU PLAN TO MATCH?    YES     NO

CHARITABLE ORGANIZATION:  ______________________________

EIN #:   ____________________                   (Name of Local 501c3 Charitable Organization)

WHAT WILL THE FUNDS BE USED FOR?   

_____________________________________________________________________________________

Please provide a brief description of the vision/mission/purpose of this organization:   (ATTACHMENTS??)

Please see Attached  __________________________________________________________________________________________________________________________________________________

I OR MY CLIENT ACTIVELY PARTICIPATES AS A…   VOLUNTEER    CONTRIBUTOR

How do you contribute to this organization?    

Please provide/attach the following materials with this request.

• Determination Letter from IRS
• Information showing a Florida corporation
• Local address
• Primary contact phone # and email
• Any other information about the organization that you think may be helpful

WILL THERE BE AN OPPORTUNITY FOR A PHOTO OP AND/OR NEWS RELEASE?

                                   YES                              NO        

WILL YOU USE THE “BIG” PRESENTATION CHECK?     

                                 YES                               NO        

POSSIBLE DATES:               

Please attach any other materials you think will assist the CBV CARES BOD with assessing this request.

RECEIVED BY:     ________________________                                   DATE:  __________

APPROVED/DISAPPROVED:         YES         NO                                     DATE:  __________

APPROVED BY:  ________________________