Hermanowski Family Foundation Initial Request Form

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Organization Name: Jeneses Haus of restoration Inc
Legal Name (if Different):
Also Known As: JHOR
Mailing Address: 11345 Tara Blvd, Ste 214
City: Hampton
State: GA
Postal Code: 30228
Main Phone: 7709061153
Main Fax:
Organization Website: www.JenesesHaus.com
Employer ID Number: 853922194
Organization Tax Status: 501c3

Proposal Information

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Today’s Date: 10/14/2022
Requested Amount: 10,000

Project Title: Home is
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: