Application

GRANT APPLICATION

The following Grant Application includes three sections that require completion:
I. Organization Information
II. Project Information
III. Required Attachments

Please review the list of required attachments to obtain additional information about the supporting documents to enclose with the completed application.

I. Organization Information

* fields are required.

*IRS Name, as listed on 501(c)3:
Organization Doing Business As, if necessary:
Organization?s Previous Name, if changed:
*Street Address:
*City/State/ZIP:
*Phone:
Fax:
*Email:
Web Site:
*Formation Date, Provided by IRS:
*Tax Exempt ID Number (EIN):
*Executive Director:
*Direct Phone:
Organization's Annual Budget:
*Revenue:
*Expenses:
*Organization's Endowment Size:
*Organization's Major Funding Source(s):
*How did the organization learn of The Mike & Mary Terry Family Foundation?
(Include contact name and relationship):
*Is the organization a previous Grant Recipient of The Mike & Mary Terry Family Foundation?
Yes No Unknown
If Yes, please provide date of the last grant:
*Please List the Organization's Geographical Focus:

II. Project Information

*Grant Request Contact Person:
*Title:
*E-mail Address of Applicant:
*Direct Phone:
Fax:
*Program/Project Title:
*Please provide a brief description of the Program/Project:
*Amount for this Request:
*Total Budget for this Program/Project:
*Total Amount raised to date for this Program/Project:
*Date Funding Decision is Requested/Needed:
*Campaign Length/Fundraising Time Period:
*Project Time Period:
*Please list other organizations that are supporting this Program/Project: (Please Include Organization Name and Dollar Amount):
*Please provide a brief demographic description of who will benefit from the Program/Project, including the number of individuals who will be impacted by both the entire program and well as this specific grant:
*Community/Counties/Geographical area served by Program/Project:
Is the organization a previous Grant Recipient of The Mike & Mary Terry Family Foundation?
Capital Endowment One-time Program/Project Operating
*Has organization received or made previous requests to The Mike & Mary Terry Family Foundation for this Program/Project?
Yes No
If Yes, please provide brief description.
*Electronic Signature: