Technology Suite Grant Application

 

Please fill out the following questions as accurately and is there early as possible in the space provided.

For development projects over $5000 we may request a list of your organization's Board of Directors, two copies of your organization's financial statements and one copy of your most recent annual report.

Primary Contact
Name *
Name
Phone *
Phone
Organization profile
Address
Address
Exexcutive Director, Owner, CEO
Exexcutive Director, Owner, CEO
Are you a registered charity or IRS approved a nonprofit organization?
Media Assessment
http://
http://
http://
Do you utilize any of the following media outlets?
What other engagement tools are of interest to you?
Project Assessment
Project start date
Project start date
$
$
Disclaimer
The information provided by applicants in this form shall not be shared with anyone else other than the applicants organization and the contacts and directors, committee members and other participants in the Cobalt Foundation Partner program. Public information will only be released if the grant application has been accepted by Cobalt Foundation Partners.
I certify that the information herein is true and correct. *
I certify that our organization is not a terrorist organization nor does it support terrorist organizations or activities.