As you complete this application please note that your submission of this document is considered confirmation that all the information included is true and correct.

Organization Information

*Organization Category

Federal Tax ID
 
*Organization Name

Also Known As
If your organization is not a 501(c)(3), does this project have a charitable component?
*Street Address
 
*City

*County
 
*State

*Zip

*Web Address

Year Organization Was Founded
Organization's Total Annual Budget
Organization’s Mission Statement
*Description of the Organization

*Relationship with BankPlus

*Organization Board Members and Officers
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*Main Contact First Name
 
Middle Name
*Last Name
 
*Title
 
*Telephone
Ext
Fax
*Email

Project Information

*Project Title

*Project Focus Area

*Project Description
Brief Description of the project and
why it is needed including evidence to support your view
 
Anticipated Results
*Description of Population Served

*Majority of Target Population

Project Start Date

Project End Date

Total Project Budget
*Amount Requested From BankPlus


Percentage of Proceeds that will directly benefit the organization
*Description of Sponsorship/Contribution Levels
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*Please list any other committed sponsors or contributors to your project

*Please describe your publicity plans for this project or event, and point out any relevant promotional or publicity opportunities for BankPlus

*Received support from BankPlus in the past year?


You will receive a confirmation page after successful submission.