Hermanowski Family Foundation Initial Request Form

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Organization Name: Test Org Name
Legal Name (if Different): Legal Name
Also Known As: Test Known As
Mailing Address: mailing add
City: Miami
State: FL
Postal Code: 33158
Main Phone: 305-203-3393
Main Fax: 303-393-3939
Organization Website: test.com
Employer ID Number: 123091-191
Organization Tax Status: 501c

Proposal Information

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Today’s Date: March 25
Requested Amount: 10000

Project Title: Test Title Project
Project Description:

Test Description

Total Project Budget: 10000

Other Funding
Sources For The Project (Committed & Potential): Other funding sources

Project Duration: Project Duration
Geographical Area Served: Area serverd
Age Group To Be Served: 14

Contact Information

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Contact Prefix (Mr,Mrs etc.): Mr.
Contact First Name: Test
Contact Last Name: Last
Contact Title: test title
Contact Phone: 309393039
Contact Email: tsontag@test.com