First Name

Last Name

Email Address

Phone

Nonprofit Name

Your Position/Title

Tell us about your mission and the purpose of this grant application, including budget.

Is your Organization a 501(C)3? Is your Organization a 501(C)3? Yes No

Does this application represent the entire expected budget for this project? Does this application represent the entire expected budget for this project? Yes No

If the Valentine Foundation does not completely fund this grant request, what will happen? If the Valentine Foundation does not completely fund this grant request, what will happen? Project will not advance Scope of project will decrease Additional funding is or will be secured

Is this a capital or operational budget item? Is this a capital or operational budget item? Yes No