The Alvah H. and Wyline P. Chapman Foundation

Grant Request Summary Form

Please view grant guidelines and grant materials checklist. Be sure to fill out information completely and enclose all of the necessary documentation that is listed. For any questions regarding grant applications or general grant request inquiries, contact CF Secretary, Kimberly Smetana.

website: www.chapmanfoundation.org

email: chapmanfoundationorg@gmail.com

Contact Name

First Name

Last Name

Contact Title

Phone

(###)

###

####

Name of Organization

Date submitted

YYYY

Address

City

State

zip code

Purpose/Mission of Organization

Please limit to 30 words

Summary of Request

Please limit to 50 words.

Preferred correspondence:

check box for preferred way to communicate.

phone

no preference

Requested Amount: $

Materials sent by mail:

Please check materials that have been mailed to The Chapman Foundation mailing address: PO Box 55398, St. Petersburg, FL 33732-5398

501c3 determination letter

list of Officers, Board of Directors or governing body

Budget for Project/organization

Financial statement of organization's most recent fiscal year

copy of grant proposal letter

Foundation Member Sponsor :

Name of Chapman Foundation member (or members) who are sponsoring this grant application.