Jablon Foundation

JABLON FAMILY FOUNDATION, CORP. 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 adminsitered 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 2027 will range from $500.00 to $3,000.00 per grant. INSTRUCTIONS 1. Fully complete, sign and date the application below. If you need additional space, please attach to the application. 2. Describe the purpose of your proposed use of the grants funds. 3. Send numbers 1 & 2, together with any supporting documentation to: Jablon Family Foundation, Corp.: sleonard@jablonfoundation.org APPLICATION FORM Deadline for filing: March 1, 2027 READ INSTRUCTIONS BEFORE COMPLETING THIS FORM. Name: __________________________, __________________________ Last First Address: ________________________________, Apt. ___________, 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 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 the selection committee, including any factors that you feel make you qualified for a grant from the foundation:________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Please list any other factors that you would like the selection committee for the foundation to consider when evaluating your application for a grant: ___________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ By submission of this application, I hereby certify that I am a United States citizen 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)