The Wicklander Family Foundation

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Grant Application

To apply for support, complete the application form below.

Application Form

Organization Name*
Contact Person*
First Last
Title*
Address*
Street Address City State ZIP Code
Phone*
Email*
Brief description of your organization*
Amount of Grant Request*
Please list other private and public funding sources for this particular request:*
Current list of principal officers and directors and board meeting dates for the last fiscal year:*
Required Attachments

Materials must be submitted in PDF format.
Grant Proposal (PDF only)*
Accepted file types: pdf, Max. file size: 16 MB.
Grant Proposal should be 1-2 pages and include geographic area and number of people to be served.
Current year's budget (PDF only)*
Accepted file types: pdf, Max. file size: 16 MB.
Current year’s detailed budget must include both projected expenses and revenues. (Categorize expenses under program, general and administrative, and fundraising. Project budget, if available.)
Audited financial statements (PDF only)*
Accepted file types: pdf, Max. file size: 16 MB.
Audited financial statements for the latest fiscal year.
IRS 501(c)3 determination letter (PDF only)*
Accepted file types: pdf, Max. file size: 16 MB.
Copy of IRS 501(c)(3) determination letter that applicant is an exempt organization under the internal revenue code.
Executive Officer Affirmation*
By submitting this application, the Executive Officer of the applicant organization affirms the following to be true:
1. The information set forth in this application and supporting documentation is correct to the best of his or her belief
2. The Internal Revenue Service determination referred to in section 11 has not been revoked, cancelled or modified.
3. No funds received pursuant to this application will be used for activities prohibited by the Internal Revenue Code of 1986 as amended.
Executive Officer Affirmation*
- Affirm
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