To Request a Grant Application

Before requesting a Grant Application Form, please review the “Who is Eligible to Apply” section of this website.

If you represent a qualified organization that believes it meets the Foundation’s criteria to apply for a grant, you may request a Grant Application Form by:

• completing and submitting the form below over the web, or
• sending a letter of inquiry that includes the information requested below.

Mail or Fax:
George S. and Dolores Doré Eccles Foundation
15 West South Temple, Suite 1701
Salt Lake City, UT 84101
FAX: (801) 350-3510

E-mail: gseg@gseccles.org

Inquiries are welcome throughout the year. If your organization and its project or program for which funding is sought, meet the Foundation’s interests and priorities, you will be provided with a Grant Application Form and instructions to prepare and submit a formal application for funding.

Grant Application Form Request

(All Fields Required)

Name of Organization:
Date Organization Founded:	mm/dd/yyyy
501 (c)(3) Name:
501 (c)(3) Number:
Date 501 (c)(3) Received:	mm/dd/yyyy
Organization Director/CEO:
Title:
Contact Person:
Title:
Phone Number:
Email Address:
Street Address:
City:
State:	Select State/Province: Utah Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming --- Not Applicable ---
Zip:
Annual Operating Budget:	(approximate amount)
Total Project Cost:	(approximate amount)
Proposed Grant Request:	(approximate amount)
Title of Proposed Project:
Organization Background Please briefly state your organization’s mission, date of last application, and a description of your organization:
Project Description Please state concisely the project/purpose for which the proposed funds would be sought:

© 2005 George S. and Dolores Doré Eccles Foundation
15 West South Temple, Suite 1701, Salt Lake City, UT 84101  (801) 246-5340  gseg@gseccles.org