Letter of Intent

Date

Name of Organization Applying

Does your organization have 501 © 3 status?

Yes

Executive Director

First Last

Phone

Contact person

First Last

If different from Executive Director

Address

Street Address Address Line 2 City State ZIP Code

Fax number

Project name

Dates of project

Amount requested

E-signature

Date

Name

First Last

Title

Need

Current Status

Current Funding Source

Potential Funding Source