Michelson Found Animals Foundation

Please complete this form and tell us how you will use free microchips to support animals in communities impacted by a natural disaster.

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* 1. What is the name of your organization?

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* 2. Is your organization a tax exempt organization, under Section 501(c)(3) of the Internal Revenue Code, or a tax exempt government entity?

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* 3. If yes, what is your organization's EIN?

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* 4. Please upload determination letter (if applicable).

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* 5. What type of organization are you? (choose one)

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* 6. What CITY is your organization located?

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* 7. What STATE is your organization located?

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* 8. Please name the primary contact for this grant.

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* 9. What is the email address for your primary contact?

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* 10. What is your shipping address?

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* 11. Please list a telephone number for the above contact person.

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* 12. What is your organization’s annual operating budget?

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* 13. How many pets do service per year?

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* 14. From which company do you currently purchase microchips?

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* 15. In multiples of 100, how many microchips are you requesting? How many microchips do you plan to implant in animals in the impacted areas within the next 30 days?

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* 16. In 150 words or less, please describe how your organization is currently helping the affected victims and how you plan to use our microchips.

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