Name of Organization
*
EIN/Tax ID#
*
501(c)(3) Status (since)
*
Phone
*
Organization Website
*
Name of Contact
*
Title or Relationship to Organization
*
Contact Email
*
Contact's Phone (if different)
Has the organization received support from SHINElife in the past?
*
Yes
No
Program or Event Name
*
Area or Community the program will serve
*
Estimated number of people served
*
Purpose of Support
*
How will a SHINElife donation assist your program?
*
How will the funds raised for the program be used?
*
Date of Program/Event
*
-
Month
-
Day
Year
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