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Grant Application
Please complete all fields and return application by mail between May 1st and July 1st to the
attention of Grant Applications, Mazda Foundation, 1025 Connecticut Ave., NW, Suite 910,
Washington, D.C. 20036.
Contact Information
Name of Organization:

_________________________________

Address:

_________________________________

City, State, Zip Code:

_________________________________

Contact Name:

_________________________________

Contact Phone Number:

_________________________________

Contact Email Address:

_________________________________

Tax ID Number:

_________________________________

Organizations Mission Statement:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Purpose for which grant is requested (Be specific.):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What area is targeted? (Please check all that apply.)
Education and literacy

Cross-cultural understanding

Social welfare

Environmental conservation

Scientific research
What age group is served?
Pre-K

High School

Elementary

College

Middle School

Adult

Elderly

Does your organization target minority populations? If so, what ethnicity is served?
(Please specify.) ____________________________
What population is served?
Women/Girls

Disabled

Rural

Other (please specify)

Urban

_______________

HIV/AIDS
Anticipated Outcome of Project:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Plans to Measure and Communicate Project Results:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Amount of Funding Requested: $___________
Fiscal year: ___________
List sources and amounts of other funding obtained, pledged or requested for this purpose.
(Please specify.)
Source

Amount

1
2
3
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6

For further information, please visit our website at www.mazdafoundation.org