Hermanowski Family Foundation Initial Request Form

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Organization Name: City LIfe Center
Legal Name (if Different):
Also Known As:
Mailing Address: 225 W 5th Ave
City: Gary
State: IN
Postal Code: 46402
Main Phone: 2198804851
Main Fax:
Organization Website: www.citylifenwi,org
Employer ID Number:
Organization Tax Status: 501c3

Proposal Information

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Today’s Date: 2/6/2024
Requested Amount: 10,000

Project Title: CLC Fines Arts Program
Project Description:

Total Project Budget:

Other Funding
Sources For The Project (Committed & Potential): City Life Center has received yearly funding from

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: