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

Grant Amount Requested

How do you intend to use the grant?

Applicant Signature (Digital)

Comments

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Edw. F. Zimmer Community Fund
PO Box 6815
Santa Fe, NM 87502