Osage Foundation Charitable Grant Application

Individual or Organization Applicant Name

Date

Person Submitting Application

Applicant’s Website

Applicant’s Address

City

State

Zip

Telephone

Is this person/organization any way connected to the Osage Nation

Yes

If answer is yes, please explain how

Has this person/organization received funding previous from the Osage Nation

Yes

If the answer is yes, please explain how much and when received

If an organization, is it a tax-exempt charity?

Yes

If the answer is yes, please attach a copy of your IRS determination letter

Upload File

If the organization is not a tax-exempt charity or individual, please explain structure

If Organization, purpose and/or mission statement

Amount of grant requested (maximum grant is $3,500)

Date Funding Needed

Project Name

Proposal Summary: In 1000 word or less, summarize the event and how the funds would be used and how the activity/project would positively impact Osages (please attach supporting document if appropriate)

Applicant's Signature

Date

Certification:

By signing this application, I certify that I am authorized to solicit funds on behalf of the above named organization or individual and, to the best of my knowledge, all information on this application and attached material is truthful and accurate and that if a grant is awarded to this organization or individual, the proceeds of the grant will not be distributed or used to benefit any organization or individual supporting or engaged in unlawful activities.

Thank you for submitting! We will get back to you as soon as possible.