Preliminary Request Form

Name of Organization or Group Requesting Funding (NOT the Fiscal Sponsor)

Brief Description of Your Group or Organization (NOT the Fiscal Sponsor)

Title and Description of Proposed Project

Amount Requested $

Actual Project Budget $

Please include your project budget with this form.

Attach your project budget sheet here

No file chosen

List of current funding sources for this project

Is the Request/Project intended to serve Humboldt County Residents?YesNo

If No, explain

Primary Contact Person and Title and/or Grant Writer

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Email Address

How did you hear about the McLean Foundation?

Please Check the Response Most Appropriate to your Organization501(c)(3)501(c)(4)Educational / Governmental InstitutionI have a Fiscal Sponsor / Umbrella Organization

Name of Fiscal Sponsor / Umbrella Corporation

EIN Number

This Form Is Not A Formal Application, Only A Preliminary Request to Determine Eligibility for Funding

Contact McLean Foundation

Phone: (707) 725-1722