Galien foundation grant application

1. Request Letter

2. Grant Application

Date of Application:

3. EXECUTIVE SUMMARY

4. Organizational Information

Certification and Signatures

I CERTIFY, TO THE BEST OF MY KNOWLEDGE, THAT:

The tax-exempt status of this Organization is still in effect,
This Organization does not support or engage in any terrorist activity, and
If a grant is awarded, proceeds will not benefit individuals or organizations supporting terrorism or unlawful activity.

Signature – President, Board of Directors:

Signature – Executive Director:

Signature Date: