Holland Community Foundation, Inc.
1996 GRANT APPLICATION COVER SHEET
  
Organization: _____________________________________________________

Address: ________________________________________________________

________________________________________________________________

Telephone: ______________________________________________________

Staff contact person: _______________________________________________

Title: ___________________________________________________________

Telephone (if different than above): ___________________________________

Date of Application: ________________________________________________

Geographic area project will serve: ____________________________________

Project title: ______________________________________________________

Type of grant:    Special project _____  Seed money_____  Capital_____        

Project date: _____________________________________________________

Year organization founded: __________________________________________

Is this organization tax-exempt under Section 501 (c)(3) of the Internal Revenue Code?
  
          Yes _____   No _____   

Is this organization an equal opportunity employer with a policy of non-discrimination in the provision of services on the basis of race, gender, religion, marital status, age, national origin, or disability?
  
          Yes _____   No _____       
  
I approve the submission of this grant request, and certify that the information contained herewith is accurate and correct:
  
Signed:__________________________   Date: _________________________ 
	  President, Board of Directors
  
       
          __________________________   Date: _________________________ 
	  Staff/Title