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2011 Grant Application for Non-profit Organization Date: _____________________ Name of Organization: ________________________________ Address: ___________________ ___________________ ___________________ Day time #:_______________ E-mail Address: ______________________________ Website Address: _____________________________ Tax ID Number: _______________________________ Organization must be a 501(3)(c) organization. Describe your organization and what you do to help children with autism spectrum disorders: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ List your organizations mission statement: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ How will your organization choose the precipitants of the Grant for scholarships? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Please provide us with a brochure of your organization. Grant Guidelines: 1. Organization must have a current 501(3)(c)tax ID number 2. Scholarships must be given to children with autism spectrum disorders. 3. Grant Scholarship money must only be used for scholarships. 4. The Parker Autism Foundation reserves the right to use your organization’s name in any form as a grant recipient, if your organization is chosen. 5. The Parker Autism Foundation also reserves the right to use the child/Children’s name in any form as a scholarship recipient. By signing this grant application you agree to all terms. It is your organizations responsibility to make sure that there are no violations of this agreement. Please have two officers sign the application. _____________________________ Signature _________________________ Title _____________________________ Signature _________________________ Title For Office Use only Application completed correctly 501(3)(c) checked Date received: __________________ __________________ Date Voted on, by Scholarship Committee: ___________________ Approved: ____________________ Not Approved: _______________ Amount Approved: _____________ ________________________________ Signature of President