Requestor Name * First Name Last Name Organization (make checks payable to...) * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email Address * Phone * (###) ### #### Website http:// Amount requesting * $ Event Date (if applicable) MM DD YYYY Sponsorship Deadline MM DD YYYY Are you a Hargrove Teammate? * Yes No Were you referred to the Foundation by a Hargrove Teammate? * Yes No If yes, by whom? Is recipient a qualified organization under section 501(c)3? * Yes No Please provide EIN# * Have you made other requests for funding from The Hargrove Foundation this year? * Yes No Description of grant request * Thank you!
