Grant Application

Please fill out the form below to apply for a grant from the Revitalize Foundation.

"*" indicates required fields

Organization Name*

Organization Address*

Street Address City State Zip

Phone*

Year Founded*

Current Operating Budget*

Mission of Your Organization*

Organization's Programs and Activities*

Area Served*

Number of Beneficiaries*

Current Funding Sources*

Executive Director/President/CEO*

Grant Contact Person/Title*

If different from above

Campaign/Project Name*

Goal of Campaign/Project*

Campaign/Project Area of Focus*

Geographic Area Served*

Campaign/Project Amount Requested*

Total Campaign/Project Amount*

Comments

This field is for validation purposes and should be left unchanged.