McCarthy Heart Hats Grant Application

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* Organization Name:

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* Organization Web Address, if available:

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* Contact Information:

Name:

E-Mail:

Phone #:

Fax #:

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* Physical address of your organization (including mailing address if different):

Address: *

City: *

State: *

ZIP: *

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* Please provide details regarding the work of the organization (no more than 150 words):

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* Please identify a specific way that a gift of approximately $15,000 would benefit your organization. (No more than 150 words)

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* Please provide the following from your year-end or most recent annual financial statements:

	Amount
Annual Operating budget	Annual Operating budget Amount menu
Total contributions received	Total contributions received Amount menu
Average corporate contribution	Average corporate contribution Amount menu

When you click done, you will have the ability to send an email. At this point, please attach a one-page summary of your latest year end financials. Thank you for your time and you will be notified in November of the status of your application.