Grant Form | Raymus Foundation

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Date Incorporated*
MM slash DD slash YYYY
Federal ID#*
Geographic area you serve*
Total persons served*
Total amount requested*
Detailed proposed use of funds and timeline*
Describe the purpose of your organization (objectives, past accomplishments, future goals, long-range plans, etc)*
Compensated executive director or president/CEO (name and title)*
How many compensated staff members do you have?*
Full time*
Part time*
Do you utilize volunteers?*
How many?
What is the fiscal year of the organization?*
List sources of income over $5,000.00*
Amount raised during last fiscal year*
What methods of fund raising are used or planned?*
Are outside fundraisers employed?*
On what basis are they paid?
Accounts are audited by*
Please specify
How frequently are you audited?*
Please specify

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Please attached the following
Copy of Internal Revenue Service 501 (C) 3 exemption letter*
Max. file size: 100 MB.
Last year’s actual profit and loss statements*
Max. file size: 100 MB.
This year’s current proposed budget*
Max. file size: 100 MB.
List of Board of Directors or other governing body or organization*
Max. file size: 100 MB.

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Certification
(To be signed by the Chairman of the Board, or other Board member.)
I certify that the aforementioned and enclosed information is complete and accurate.
Signature*
Title*
Date*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

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Antone and Marie Raymus Foundation
544 E Yosemite Avenue, Manteca, CA 95336
info@raymusfoundation.org | (209) 823-3148

General Information