PAUL PALANK MEMORIAL FOUNDATION PRE-APPLICATION
Are you an IRS 501 (c) (3) ?
If you have answered YES to the above question, please continue with the Pre-application

If you have answered
NO to the above question, we thank you for your interest in Paul Palank Memorial Foundation, however, we are
unable to assist you.  Please visit our
Contact Us page for useful links.
ORGANIZATION INFORMATION
Name of Organization
Mission/Vision Statement
Organization Head
How many staff do you have?  Please list key players and their positions.
Physical Facility Address
Mailing Address (if different from above)
Telephone Number - (xxx) xxx-xxx
Fax Number - (xxx) xxx-xxx
E-mail address
Website URL
Facebook Page URL
Annual Organization Budget in $ Dollars
PROJECT INFORMATION
Project Name (This is how you will be known to us on all correspondence.  Please make note of the exact entry.)
Project Contact Name & Title
Telephone Number - (xxx) xxx-xxx
Fax Number - (xxx) xxx-xxx
E-mail address
Please provide a brief description of the project/program for which you are seeking funding including purpose of
request and program area.  
PLEASE LIMIT YOUR ANSWER TO 200 WORDS
Amount Requested In $ Dollars
How are funds to be spent?
Age of Population?
This project is a(n)
Number of people to be served
I hereby certify that I am authorized by this organization to submit this Pre-application and that I am an IRS 501 (c) (3)
organization with a current determination on file and that the organization has not received notice from the IRS of any
proposal, threat, or suggestion to revoke or modify this determination.  My typed electronic signature below affirms this
certification and authorization.