Application

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)

Amount of Grant Requested $*

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

Application Entity Name*

Street Address*

City

State

Zip Code*

EIN*

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

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

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Describe the applicant’s purposes and activities in general. (Attach)

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

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

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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.

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Attach list of Board Members including titles.

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

Name*

Title

Phone Number*

E-mail*

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*

Title or Office