Hermanowski Family Foundation Initial Request Form

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Organization Name: Victory Junction Gang Camp, Inc.
Legal Name (if Different): Victory Junction Gang Camp, Inc.
Also Known As: Victory Junction
Mailing Address: 4500 Adam’s Way
City: Randleman
State: North Carolina
Postal Code: 27317
Main Phone: 3364952066
Main Fax:
Organization Website: www
Employer ID Number:
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: