KIP Grant Application | United Way of Southwest Minnesota

PART I - Organization Information

Organization Information

Organization's Name

Organization's Address

Address

City

State

ZIP Code

Mailing Address (if different)

Address

City

State

ZIP Code

Organization's Phone Number

Organization's Fax Number

Organization Mission Statement

Organization's Web Address

We are an informal group - we do not have any formal legal structure.

Yes

No

We are an informal group but have partnered with a non-profit/fiscal agent.

Yes

No

Fiscal Agent Federal Tax Identification Number

Are you a 501c3 Organization

Yes

No

Organization Federal Tax Identification Number

We are a public agency/unit of government.

Yes

No

Organization Federal Tax Identification Number

We are a for-profit entity.

Yes

No

Primary Contact Information

Primary Contact First Name

Primary Contact Last Name

Primary Contact E-Mail Address

Primary Contact Phone