Grant Application To

Alexandria United Methodist Trust Fund

(Additional sheets may be attached as needed to answer the questions below.)

ORGANIZATIONAL NAME: ________________________________________________________________________

MAILING ADDRESS:

Street_______________________________________________________________________________________

City_____________________________________________   State____________ Zip____________________

Does this organization have a 501.c.3 status:  ____Yes   ____No?

What is the main purpose of this organization?

What is the geographic location of the primary service area?

What is the primary source of funding for this organization?

What is the annual budget for all operations of this organization?

What is the governing structure of this organization—number of persons on the Board of Directors etc.

Outline the general purpose of this grant application. What will be accomplished if this grant is awarded? (Please no requests to cover operational expenses)

How much is the grant request? Approximately how many people will be affected by this grant?

Signed___________________________________________________________ Date _____________________________