Grant Application - Page I

General Information Form

Stamm Koechlein Family Foundation

1.  Organization name_____________________________________    Date ____/____/_______

2. Address __________________________________________________________________________

        City, State & Zip __________________________________________________________________

3.  Contact Person & Title: ___________________________________________________________        

        Email:______________________________________________________________

4.  Amount Requested______________________________________________________________
 

5.   Type of request:     ____ General support     ____ Start-up costs   ____ Project support     ____ Technical assistance

                    ____ Endowment    ____ Capital expenditures    ____ Other       

6.  Project Title______________________________________________________________             Project start date                             

7.  Is this a new program for your organization?   Yes____  No____

8.  Previous funding from the Foundation?            Yes ____ No____         If yes, when and for what amount?________________________

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Stamm Koechlein 2007 Grant Application Page 1

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