Fueling the Future Form

Today's Date:

Organization Name:

Name of Contact Person:

Contact Mailing Address:

City:

State:

Zipcode:

Contact Phone Number(s):

Contact Email Address:

Please describe what type of donation you are seeking and how that support will be used:

If this request is for in-kind goods or services, what kind of specific gifts or services are you requesting?:

If Fueling the Future Foundation awards your organization a donation, but you do not reach your fund raising goal, what will happen to the support/donation that we give you?:

Please describe what other efforts you are undertaking to reach your fundraising goal:

If there is any additional information about your organization or event that you believe further supports your request, please attach that printed information to this application. Please note: A completed application is NOT an agreement to honor your request. It should also NOT be implied that the request will or would be funded in its entirety. By submitting this application with your signature below as the Contact Person for the organization making the request acknowledges that you have read and agree to the Donation Criteria attached to this application form.

Signature of Contact Person: