Grass Roots Grants Application - Edw. F. Zimmer Community Fund

Nonprofit Name

Contact Name and Title

Mailing Address

Street Address Address Line 2 City State ZIP Code

Is your physical address different than your mailing address?

Yes

Physical Address

Street Address Address Line 2 City State ZIP Code

Phone

Website

FEIN #

Date of Last NM-COROS Filing

Date of Last US-990

# Paid Employees

# Years in Operation

# Volunteers

Mission Statement

Service Description

Service Recipient

Service Area

Have you received a grant before?

Yes

If yes, how did you use the grant?

Date Requested

Annual Amount Requested

How do you intend to use the grant?

Applicant Signature (Digital)

Phone

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

Edw. F. Zimmer Community Fund
PO Box 6815 | Santa Fe, NM 87502
505466-1676 | k-zimmer@comcast.net

Please remember to e-mail a few photos of your program at work when you transmit the application. And, if you are applying for a targeted grant, contact us for supplemental information guidelines tailored to your project. Follow up with us in a week to confirm we have your complete application.