Funding Request [ Home ] [ Our Founders ] [ About Us ] [ Grant Making Policy ] [ Contact Information ]
Please fill out the form below as completely as possible. Press the submit button on the bottom of the page when you are finished or press reset to clear the form.
Organization Information
Legal Name Of Organization:
Year Founded:
United Way Agency: Yes No
Current Year Operating Budget: $
Mission Statement: (200 Character limit)
Project Information:
Project Name:
Project Description: (450 Character limit)
Project Start Date:
Project End Date:
Geographic Area Served:
Target Age:
Target Gender: Neutral Female Male
Target Ethnicity:
Funding Information
Have you previously received help from the Keller Foundation? Yes No
Total Project Cost:
Amount Requested:
Disbursement: As a One Time Donation As an Annual Donation for 1 2 3 4 5 6 7 8 9 10 year(s).
Major Funding For This Project
Organization
Amount Requested
Amount Committed
Amount Received
In Kind
Frey Foundation:
$
Grand Rapids Foundation:
Steelcase Foundation:
Other 1:
Other 2:
Other 3:
Contact Information
Exec. Director / Chief Operating Officer:
Form Completed By:
Administrative Office Information
Street Address: City:
State: Zip Code:
Phone (Including Area Code):
Fax (Including Area Code):
Email:
Web site:
Attachments and Methods of Transmission -Mark all that apply-
Copy of 501(c)3 tax status (required)
Brief cover letter introducing your organization
List of board directors
Additional information or support documentation that will help in the decision process
Documents sent by:
U.S. Post to: Keller Foundation 5225 33rd St. SE., Grand Rapids MI, 49512
Email to: zelene@kellerfoundation.org