FUNDING Initiative Program Application

Date

Organization

Address

City, State

Country, Postal Code

Phone Number

Director of Development: First and Last Name

Director of Development: Phone

Director of Development: Email

Program Contact: First & Last Name

Program Contact: Title

Program Contact: Email

Program Contact: Phone

Organization Web Address

Facebook Page (if applicable)

Other Social Media Accounts

Month Requested To Begin Program (i.e. Jan, Feb)

Target Funding Goal for Campaign

Plans for Promotion of Campaign