Hermanowski Family Foundation Initial Request Form

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Organization Name: I.C.A.R.E. Ministries Out of School Time Program
Legal Name (if Different):
Also Known As:
Mailing Address: 4950 W. Thomas (entry on Lavergne Street)
City: Chicago
State: IL
Postal Code: 60651
Main Phone: 7738036380
Main Fax: N/A
Organization Website: Website: icareministrieschi.com
Employer ID Number: 363947794
Organization Tax Status: 501C

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: