WebGrants

Personal Information

Name:*


Salutation	First Name	Middle Name	Last Name

Title:

(example: individual artist, executive director, development director, board member)

Email*

Confirm Email*

Phone*


Phone	Ext.

Mobile Phone:

Organization Information

Legal Name:*

Popular Name*

Street Address

Street Address:
No PO boxes.*

City:*


City	State/Province	Postal Code/Zip

Mailing Address:
(if different from above)

City:


City	State	Postal Code/Zip

Website:

Applicant Type:*

Primary Arts Discipline

Primary Arts Discipline/ Activity (choose one):*

Non Profit Status

Non-Profit?*

Yes No

If No, Fiscal Sponsor:

Date Incorporated:

Federal ID:

Secondary Contact Person

Secondary Contact Person Name:*

Title:

Phone:*


Phone	Ext

Email:*