Grant Interest Form : Grant Interest Form : The Ethel S. Abbott Charitable Foundation

This form is intended to provide us sufficient information to make a determination if there is enough preliminary interest by the Foundation to have you complete our detailed grant application form.

Legal Name of Organization

Address of Organization

City, State & Zip Code

Contact Person & Phone #

Contact Person E-mail Address

Are you exempt under I.R.S. Code Section 501(c)(3)?

Is your organization located in the State of Nebraska?

Grant Request

Total Cost of Project Associated With This Grant Request

Total Amount of Grant Request

Is this a multiple year grant request?

If yes, Please indicate the number of years for this grant request

Indicate the Starting Date for Funding of this Grant Request

Month

Day

Year

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Short description of the grant

Include in your description what the grant is for, why you need the grant, who will benefit from the grant and what other community support you have for this grant.

To the best of your knowledge has your organization previously requested a grant from The Ethel S. Abbott Charitable Foundation?