MWYF Pre Grant — Mark Wahlberg Youth Foundation

Today's Date

Legal Name of Organization

Name of Executive Director

First Name

Last Name

Office Mailing Address

Name of Primary Contact

First Name

Last Name

Primary Contact Phone

(###)

###

####

Primary Contact Email

Primary Contact Title

Is your organization an IRS 501(c)(3) tax exempt organization?

Yes

Please provide EID/EIN#:

Request Amount

Please state your organization's mission:

What is the name of the project/program that will benefit from this grant?

(If this is for general operating support please indicate that)

Please provide a brief description (no more than four sentences) of the project/program

Total number of Board members

Number of full time staff

Number of part time staff

Total annual organizational budget

Fiscal Year End

Period this grant will cover

Have you received previous support from the Mark Wahlberg Youth Foundation?

If so, please indicate how much and when that support was provided

Referral Source

Thank you for your application for support from the Mark Wahlberg Youth Foundation. We will follow up with you by email directly shortly. Should you have any questions or need any additional information in the meantime, please feel free to reach out to Ashley directly: ashleywebb79@gmail.com