The Rasheed A. Wallace Foundation | Grant Application Process

Education/Recreation Program Grant Application

Name of Grant Recipient:____________________________

Address:____________________________

Date of Grant Application: Telephone Number:____________________________

Contact Person:____________________________

Relationship:____________________________

Amount Requested/Rationale:Purpose/Objectives:____________________________

Project start and completion dates:____________________________

Person authorized to receive grant funds:____________________________

Address:____________________________

Telephone Number:____________________________

Check appropriate box:
[ ] 501(c)(3) Exempt Organization
[ ] Education/Recreation Program

Signature of Authorized Representative:____________________________

PLEASE PRINT THIS FORM AND MAIL IT TO US AT THE ADDRESS ON THE LEFT