Community Impact Grant

Group Name

EIN

Leader Name

Contact Person (if different name):

Mailing Address

City

State

Zip Code

Telephone Number

Email Address

Amount of Request

Name/Title of Project

Describe Project

Centerville Washington Foundation grant goals: To promote opportunities that benefit the citizens of Centerville/Washington Township, to launch new projects that represent a unique and unduplicated opportunity for the community, to support established organizations for special purposes and to generate matching funds. How does this request support the Foundation's purpose?

What is the geographic area being served?

What is the population of the geographic area?

What other sources of funds will you explore or do you expect to support this request?

When will the funds be required?

What is the full budget for the project?

How are additional funds to be raised?

Please list previous projects funded by the Foundation in the last three years:

Most Recent Year End Revenue:

Most Recent Year End Date

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