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Artist/Organization Information

Applicant Organization:
Address:*
Phone:*
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Fax:
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County:
Website:
Executive Director or Principal:
Email:
Project Director or Teacher (if different):
Email :
Title (if different):
Email

Tax Status

Tax Status (check one):
Fiscal Sponsor Name:
Legal Name, per IRS determination:
Tax ID #:
Date of IRS letter:

Organization's Mission

Brief statement of organization’s objectives and/or activities:
Annual operating budget:
Audited?

Summary of Request

Project/Program Title:
Date of inquiry:
Timeframe for project requested:
From:
Describe how your organization will partner with ArtReach Orlando (i.e.: staff, clients)

Project/Program Summary

Summary of Project or Program (suitable description to be shared with Foundation staff, board, and/or donors) 150 words or less.
Who wi ll this project/program serve? (special populations, geographic area, community focus, organizational focus, etc.)
Provide one or more outcomes you expect to achieve. Be specific.
Please list other support you are seeking fro foundations/government agencies, as well as any potential partnerships with other nonprofits on this project.

Comments

Is there any other information we might need to better understand your request and/or the unique needs of the community that this request will serve?
Verification: