Contribution Application

Applications are accepted and reviewed on an ongoing basis. Decisions on applications are generally made within four months of submission, depending on the request. Every application submitted in writing will receive a response.

The completed application form should be directed to:

Contributions-A2
Wisconsin Public Service Foundation
700 North Adams Street
P O Box 19001
Green Bay, WI 54307-9001

Please enclose the following information with this application:

List of the organization's officers and directors
Complete budget for the project
IRS form 501(c)(3) tax determination letter*
Audited financial report*
Current annual operating budget*

* Required for requests over $500 only.

Contact Information Date of Application: (example: 01/01/2001)
Organization Name:
Contact Person:
Title:
Address:
City:
State:
Zip Code:
Telephone Number: - - (example: 123-456-7890)
County or Areas Served:
Amount Requested:
Total Project Cost:

Contribution Information Purpose: Advertising
General Operating
Capital
Program
Other:

Project Information Describe the Project:

Organization Information Describe Organization: Employees Involved
in Fund Drive: Additional sources from
whom funds for this request
being sought:

Additional Information What acknowledgement would
the Foundation receive
for making a donation?

Wisconsin Public Service

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Contribution Application