Hermanowski Family Foundation Initial Request Form

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Organization Name: Advocates for Pets of Loudon County TN
Legal Name (if Different): Loudon County Humane Society
Also Known As: Advocates for Pets of Loudon County TN
Mailing Address: P. O. Box 602
City: Lenoir City
State: Tennessee
Postal Code: 37771
Main Phone: 865-408-8836
Main Fax:
Organization Website: aplctn.org
Employer ID Number: 62-1400713
Organization Tax Status:

Proposal Information

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Today’s Date:
Requested Amount:

Project Title:
Project Description:

Total Project Budget:

Other Funding
Sources For The Project (Committed & Potential):

Project Duration:
Geographical Area Served:
Age Group To Be Served:

Contact Information

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Contact Prefix (Mr,Mrs etc.):
Contact First Name:
Contact Last Name:
Contact Title:
Contact Phone:
Contact Email: