Janis Chapman Merrill Foundation

Online Application for Grant from Private Foundation

The mission of The Janis Chapman Merrill Foundation is to support 501(c)(3) organizations that serve the health, education and/or welfare of children and their families and the homeless, focusing on Arizona.

In your application materials, please show how your organization will be able to use the funds to further the stated goals of our foundation.

(Not for use by Individuals)

Application Form

Application

The information requested in this application is to help the Foundation meet the requirements of Section 4945(h) of the Internal Revenue Code.

Grant Amount

Application Entity

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Country

EIN

Phone

Is the applicant organized as a nonprofit organization under state laws governing charitable organizations? (Attach Proof)

Yes

File Upload

Attach File Here

Has the applicant received a ruling or determination letter from the IRS relating to their charitable status? (Attach copy of such letter)

Yes

File Upload

Attach File Here

Describe the applicant’s purposes and activities in general.

Attach File Here

Attach a copy of the latest information return (Form 990 or 990PF) filed by the applicant with the Internal revenue Service.

Attach File Here

Explain in detail, the proposed project or program for which the grant funds will be used.

Attach File Here

Is the applicant controlled by, related to, connected with, or sponsored by another organization? If yes, identify organization including its purpose and activities, and explain relationship.

Yes

File Upload

Attach File Here

Attach list of Board Members including titles.

Attach File Here

Person to contact who will be administering the program or project.

First Name

Last Name

Title

Phone/Mobile

From my knowledge of the information provided in this application, I avow that the information is correct. The applicant organization has authorized me to make this application.

Name

Date / Time

Title / Office