COVID-19 Emergency Sanctuary Grant

Name:*

First

Last

Your Title*

E-mail:*

Phone (cell preferred)*

Area Code

-

Phone Number

Name of Organization:*

Organization Address:*

Street AddressCityState / Province / RegionPostal / Zip CodeCountry

Organization website*

Federal EIN #*

2019 Expenses (Jan 1 - Dec 31)*

2019 Income (Jan 1 - Dec 31)*

Balance of savings/investment as of April 20, 2020:*

2020 Income (Jan 1 - April 20)*

2020 Expenses (Jan 1 - April 20)*

What are three actions you are taking to be more financially secure?*

Amount you are requesting *

If approved, how will you use these funds. Please be as detailed as possible.*

REQUIRED Upload most recent Form 990 or 990-N (max file size of 4MB). Trouble submitting? Email to marji@animalplace.org as a pdf.

Will you be able to provide a report within 3 months of fund disbursement?*

I understand this is only for animal care uses (feed, bedding, salaries, medications, veterinary care)*

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