Hermanowski Family Foundation Initial Request Form

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Organization Name: Blueprint 58
Legal Name (if Different): Blueprint 58 Inc.
Also Known As:
Mailing Address: 830 Glenwood Ave SE Suite 501 – 291
City: Atlanta
State: Georgia
Postal Code: 30316
Main Phone: 678-907-7589
Main Fax:
Organization Website: https://blueprint58.org/
Employer ID Number: 27-4649809
Organization Tax Status: 501 (c) (3)

Proposal Information

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Today’s Date:
Requested Amount: $5,000

Project Title: Mentor Program
Project Description:

Total Project Budget:

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

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

Contact Information

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Contact Prefix (Mr,Mrs etc.): Mrs.
Contact First Name: Rebecca
Contact Last Name: Stanley
Contact Title: Executive Director
Contact Phone: 678-907-7589
Contact Email: rebecca@blueprint58.org