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Application Form
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Resources
Application Form
Tell Us About Your Organization
Organization Name
*
Name and Title of Individual Completing Form
*
Executive Director
*
List of Board of Directors or Trustees
*
Max. file size: 50 MB.
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Telephone Number
*
Fax
E-mail Address
*
Website Address
Is the organization: A 501(c) 3 organization?
*
Yes
No
If no, BINF cannot consider request
Please upload a copy of your 501(c) 3 classification from IRS
*
Max. file size: 50 MB.
Please upload a copy of your 990 Form from previous year
*
Max. file size: 50 MB.
Mission Statement of the Organization
Organization' Activities Focus On
Healthcare & Human Service Programs
Education
Job Development
Youth Services
Recreational
Programs for at-risk youth or low to moderate Income: individuals or families
Other
Other
*
You selected "Other" please specify.
Current Services Offered
*
Tell Us About The Requested Donation
Name and brief description of the program or project for which you are requesting funding:
*
Amount of request (USD)
*
In-Kind Service/Contributions (USD)
*
Please upload your itemized budget to equal the requested amount
*
Max. file size: 50 MB.
Please upload itemized budget which reflects current year revenue and expenses
*
Max. file size: 50 MB.
Number of people served
*
Age Group (youth seniors, etc.) Served
*
List other organizations with which you are collaborating on this program or project:
*
Please describe your work plan goals for this project:
*
How will BINF be recognized for this donation?
*
Please check the # of years your organization has been in operation:
1-3
3-5
5-7
7+
Key Dates:
Date of event/program:
*
Month
Day
Year
Date by which donation need to be received:
*
Month
Day
Year
Program Start:
*
Month
Day
Year
End Date:
*
Month
Day
Year
Sign by Printing Your Full Name
*
Please check the box below to indicate you agree to the statement
*
I agree that the printed name above is recognized as my authorized signature.