Funding

Organization Information

Organization Name:

Tax ID #:

Are you a 501c3 not for profit?:

Street Address:

City:

State:

ZIP Code:

Website:

E-mail address:

Contact Name:

Work phone:

Please list the services you offer:

Please list the team sports you offer:

Please list the individual sports you offer:

Communities

Please list the communities your organization supports:

Description of Financial Need

Please describe the specific need/project of your organization. Ex. How many kids would get funded through this project, scholarship, league/team? As much detail as possible would be helpful. If you have individual cost breakdowns, it would be helpful.

Why is this project important to your organization?

Other sources of funding

Measure effectiveness of project:

Brief history of your organization:

Experience of past work and/or projects of your organization:

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Our goal is to provide opportunities to as many kids as we can to make sure they have the opportunities.

When Accepting funds we will ask the organization for the following:

1. A couple of photos from activities at the organization to be used in newsletters, website, presentations, etc. No names will be identified with the children.
2. When appropriate, we would like the Putnam Foundation logo placed on Uniform.
3. Acknowledgement in Organizational publication of partnership.
4. Photos from activities at the organization to be used in newsletters, website, presentations, etc. No names will be identified with the children.
5. When appropriate, we would like the Active4Youth logo placed on uniforms.

Thank you for completing this application form and for your interest in working with us.

Agreement and Signature

Signature:

Date: