Funding Request Form 2025 – Grace Dart Foundation

Name of Organization

Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Charitable Registration Number from Canada Revenue Agency

Contact Person

Person in Charge

Telephone Number

of 1-year Project

Website (if applicable)

How does your organization identify?

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

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