Please enable JavaScript in your browser to complete this form.Your Name *FirstLastYour Organization Name *Organization AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Your Organization WebsiteOrganization Founding Year *IRS Status501c3Not 501c3Program Priority * Arts and CultureCommunity and Economic DevelopmentEducation (early education and K-12)Human Services ( Disaster, Poverty, Hunger, Homeless, Crime, Crisis, Disability)Social Justice / AdvocacyName of Counties servedSelect State List (Cost $75.00) * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOther Comments *Total$ 0.00I understand that by placing this order, I am going to receive a customized list of grant-making organizations, and that does not guarantee a grant award. This list is intended for personal use, and is not to be used for commercial purposes to sale or redistribute. You agree to use the requested list as intended. Thank you! * Yes, I agreeMessageOrder