Current Organization Information Program/Project Information Funding Request Summary Supporting Documents Complete Requesting Organization Tax ID Number Contact Information Contact Name Contact E-Mail Address Daytime Phone Address Line 1 Address Line 2 City/Town State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Availability of your services is restricted on the basis of race, sex, national origin or religion. Yes No Please explain the restriction. You refuse/restriction services to people unable to pay. Yes No The organization is local and delivers services to populations residing in Froedtert Hospital’s Service Area. Yes No The organization is a unit of a national organization. Yes No National Organization Name You qualify as a not-for-profit organization under provisions of the Internal Revenue Code. Grant requests from individuals not accepted. Yes No Not applicable You will need to include 501(c)(3) verification in the documents section later in the application. Save Draft Continue to Program/Project Information