APPLICATION MUST BE TYPED

THE EVJUE FOUNDATION, INC.

APPLICATION FORM
Please attach a copy of your organization's IRS tax exempt status letter if not
already submitted within the last several years. If your organization is not a registered 501(c)(3), you
must affiliate with another agency to serve as your fiscal agent. A letter of agreement and a copy of
that fiscal agent's 501(c)(3) must accompany this application. Submit completed application to The
Evjue Foundation, Inc.,1901 Fish Hatchery Road, Madison,WI53713.

Organization

Address City State Zip Code

Telephone Grant contact person, title

List members of your current Board of Directors:

Amount requested $

Has your organization received a grant in the past from our foundation? If so, please list
the year and amount and provide a one paragraph explanation of how the money for the
most recent grant was used as well as describing the outcome of that activity.

Briefly supply us with the following (use back if necessary):

1. Summarize the purpose, objective and the impact of the grant request on our
community

2. Total budget for your project and other sources of financing

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(This application must be signed by an officer of the organization’s governing body)

Signature Title

Date
EVJ.FORM:3/00 Request No.

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