Grant Request Form - Pillars with Purpose

Name of fund you are requesting a gift from:*

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Name of person requesting gift:*

Date*

Requestor phone number:*

Requestor Email*

Gift requested for (name of non-profit):*

Contact Person (at non-profit):

Phone Number (at non-profit):

Email (at non-profit):

Address (at non-profit):*

Street Address Address Line 2 City State ZIP Code

Non-profit’s Website*

Purpose of Gift*

Amount Requested: $*

Communities/Counties/Constituencies served by this non-profit:*

Additional Questions

Why is this organization important to you?*

What services does this organization provide in your community or others’?*

Have you been a volunteer to this organization or made a financial contribution?*

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