Request a Grant for Your Charitable Organization

Request for Donation Application - Charitable Organization Form

Legal name of charitable organization and 501(c)3 number

Contact person/title from organization

Contact Email

Contact Phone

Additional Contact information and website

Donation amount requested and how this figure was determined?

Requested date for receipt of donation?

Organization Information

Please provide the following information in the box below.

• Summarize your organization’s history.

• State the organization’s mission and goals.

• Outline current programs and activities.

• Highlight organizational accomplishments.

Purpose of Donation

What is the purpose of this donation? Write about the following in the box below.

• Describe the proposed use of the donation.

• Identify the target community served and how they will benefit.

• How will you reach this community?

• Explain how the donation will contribute to and/or impact the community.

• Provide a timetable for use of the donation.

• Is this a request for a one-time donation or annual giving?

Promotion and Award of Donation

Describe how this donation with be promoted in the community? Write about the following in the box below.

• How will this donation be promoted in the target community?

• Will the Rob Benzon Foundation be named specifically during the promotions?

• Is there any type of check presentation or award banquet planned?

• How can the Rob Benzon Foundation stay informed about the use of the donation?

Once we receive your information, we will be following up with you to provide the following:

• Copy of the current IRS determination letter indicating 501(c) 3 tax-exempt status.

• List of Board of Directors including affiliations, tenures, and terms. What percentage of the Board of Directors financially supports the organization?

• Annual Report (if available)

• List of other donating organizations and/or potential donators and amounts committed or requested.