Grant Application

*Field not required

Section 1 - Organizational Information

Organization legal name

Street Address

*Street Address (optional space if needed)

City

State Zip

Main phone number

Executive Director

Year Founded

Current Operating Budget

Tax Status Number

*Website (www address)

Has this organization previously submitted a grant application to DENSO?

In one paragraph, 30-50 words, describe the mission of the organization

Section 2 - Primary Contact Information

Prefix

First

Last

Title or Position

Email address

Phone

Fax

Section 3 - Grant Project Information

Project Name

Grant Category

Time Frame: Start End

Total Project Cost Amount Requested Product Donation

Is this multi-year request?

Summary Description of Project, one page or less.

Include but do not be limited to the following information 1) overall scope 2) desired result 3) how DENSO grant funds would be spent (be specific).