Funding Request Form – Grace Dart Foundation

Name of Organization

Address (Number, Street, City, Postal Code)

Charitable Registration Number from Canada Revenue Agency

Contact Person

Person in Charge

Telephone Number

Website (if applicable)

How does your organization identify?

Community Organization Research CIUSSS/CISSS/Santé Québec:

Other:

Amount requested for the project

Other sources of funding (grants, donations, etc.)

How does your project meet our Areas of Giving in support of the elderly (select all that apply)

Title of Project

Please provide a brief description of the project (500 words or less)

Approximately how many older adults will be impacted by this project? (over a 1-year period)

Recognition and/or visibility offered

Attachments (Max. 3 documents in PDF. Attach all documents simultaneously)

The Foundation strongly encourages its partners to use electronic media all the while contributing to lowering our environmental impact.

1. 1. Use the online form.
  2. Include up to a maximum of 3 documents, if necessary.
    No additional documents will be accepted.