Hermanowski Family Foundation Initial Request Form

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Organization Name: Lorenzo’s House
Legal Name (if Different):
Also Known As:
Mailing Address: 5145 N. Glenwood Ave
City: Chicago
State: IL
Postal Code: 60640
Main Phone: (773) 217-8310.
Main Fax:
Organization Website: lorenzoshouse.org
Employer ID Number: 87-1604169
Organization Tax Status: 501c3 (non-profit organization

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: