eTapestry

Dates of Prior Submissions:

Organization Contact Information

Organization Name:

Organization's Phone:

Organization's Fax:

Organization's Website:

Executive Director or Authorizing Official of this Organization:

Grant Contact:

Grant Contact's Title:

Grant Contact's Phone:

Grant Contact's Fax:

Grant Contact's Email:

Board Chair:

Board Chair's Phone:

Organization Summary

Is your organization and IRS designated 501(c)(3) organization?: -- Yes No

Please provide your nonprofit ID number:

Year that your organization was established:

Total annual organization budget for last 3 years:

Surplus or deficit in last 3 years?:

Organization Mission:

Primary services of the organization:

Grant Request Information

Is the grant request for a new project or program?: -- Yes No

Name of the Foundation Staff, Donor Advisor, or Board Member, you may have spoken with:

What is your request to the foundation? ($100 - $1000):

Briefly describe the purpose of the request and the proposed activities for which you are seeking:

A brief description of the target population that you intend to serve with this grant (demographics, number to be served):

Geographic area of the target population:

Total cost for proposed project:

Total dollars committed to date for the proposed project:

Request to the Blackbaud Indianapolis Fund as a percent of total cost:

List the major cash (with amounts) or in-kind services already secured/committed for the proposed project:

How will the project sustain itself in subsequent years?: