THE ELIZABETH BUTLER ANGEL FOUNDATION
GRANT REQUEST FORM
P.O. Box 228
North Salem, NY 10560
(914) 729-1969 // e-mail: SpiritofElizabeth@msn.com
Organization Information
____________________________________________________________________________________________________________________________
Name of Organization Legal name, if different
____________________________________________________________________________________________________________________________
Address City State, Zip
____________________________________________________________________________________________________________________________
Phone Fax Web site address
____________________________________________________________________________________________________________________________
Name of contact Title Phone Email
Grant Request Description
Please describe request below:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Teen-Dating-Abuse Awareness Counciling will be (please check one):
Provided In-House: ____________________ Delivered by Non-Profit Organization: ________________________
Budget
Amount requested:
Description: ______________________________
$ ______________________________
Description: ______________________________
$ ______________________________
Description: ______________________________
$ ______________________________
Number of Participants:
____________________________________________
SIGNATURE _____________________________________________ DATE
____________________________________________
FOUNDATION USE ONLY
Date Received:
_________________________________________________
Authorized By: _________________________________________
Notes: _____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
"Our goal is to help all young adults understand and implement the concepts of open communication, self-discipline,
and self-respect in relationships. The fund will help young women and men understand their innate value as people and teach
the warning signs of domestic violence."
EGB Grant Request Form – 6/23/08