Hermanowski Family Foundation Initial Request Form

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Organization Name: Test Org
Legal Name (if Different): test
Also Known As:
Mailing Address: 123 adres
City: miami
State: fl
Postal Code: 33134
Main Phone: 3059292929
Main Fax:
Organization Website: domatic.com
Employer ID Number: 120929-19
Organization Tax Status: exempt tax

Proposal Information

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Today’s Date: march 19,2015
Requested Amount: 10000

Project Title: Title of project -testing testing
Project Description:

this isa a test description.

Total Project Budget: 10000

Other Funding
Sources For The Project (Committed & Potential): Test Srouces

Project Duration: 10 months
Geographical Area Served: Florida
Age Group To Be Served: 16-19

Contact Information

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Contact Prefix (Mr,Mrs etc.): MR
Contact First Name: todd
Contact Last Name: test
Contact Title: test title
Contact Phone: 3052230292
Contact Email: tsontag@domatic.com