Key Contact Name *

First Name

Last Name

Key Contact Phone *

(###)

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Executive Director or President *

First Name

Last Name

Executive Phone *

(###)

###

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Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Physical Address (if different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Main Phone

(###)

###

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Date Founded *

MM

DD

YYYY

Date of Request *

MM

DD

YYYY

Grant purpose - Please confirm these align with our guidelines *

2020 applicants must focus on both youth causes and at least one of these issues. Check all that apply.

Social Justice- Advocate for equal rights, opportunity, and treatment of others

Diversity and Inclusion- Your organization embraces individuals of all backgrounds, race, disability or situation

Start date when funds will be used

MM

DD

YYYY

End date when funds will be used

MM

DD

YYYY