JABLON FAMILY FOUNDATION, CORP.

Application

APPLICATION FOR GRANT: Jablon Family Foundation, Corp., is a 501(c)(3) organization that provides a limited amount grants to organizations or individuals that advance research, treatment and assistance in the illnesses associated with Cancer, Alzheimer’s, Lung diseases, Epilepsy and mental health. The grants may be for expenses related to an organization or individual’s needs and are administered at the determination of the Board of Directors of the Foundation. The Board of Directors will evaluate the Applications it receives and determines grant amounts based on need and available funds.

 

Organizations or individuals receiving grants will be subject to reporting requirements to the Foundation. The grants for 2020 will range from $500.00 to $2,000.00 per grant.

 

INSTRUCTIONS

Fully complete, sign and date the application below. If you need additional space, please attached to the application.

 

Describe the purpose of your proposed use of the grants funds.

Send numbers 1 & 2, together with any supporting documentation to:

Jablon Family Foundation, Corp.: rjablon@jablonfoundation.org 

with a copied faxed to 1-866-847-2922


APPLICATION FORM

Deadline for filing: May 1, 2020

 

Organization Name and contact person: 

_________________, _______________

Address: ________________________, City ___________, State __ Zip ________

Phone Number: (____) ____________ Fax Number: (____) ___________

Mailing Address (if different from above): ______________________________________________________

E-mail address: ______________________________________________________

Applicant’s intended/proposed use of grant, including area of illness association from the list above:

______________________________________________________

Please state the dollar amount you are requesting, 

including all uses thereof:____________________________________

Please explain the financial factors that you would like to have considered by our selection committe, including any factors that make you qualified for a grant from the Foundation: ___________________________________ 


Please list any other factors that you would like the selection committee for the Foundation top consider when evaluating your application for a grant:

_______________________________________________________

By submission of this application, I hereby certify that I am a US citizen, 

the organization I represent is a valid not for profit corporation of the US,

 and the information contained herein is correct to the best of my knowledge. I hereby authorize the Foundation to request any and all 

records to verify the 

information contained herein. 


_________________________ (signature and date)