THE POWELL FOUNDATION PROPOSAL SUMMARY

Name of Organization _______________________________Date_______

Physical Address______________________________________________

Mailing Address (if different)_____________________________________

Telephone ___________________________Fax_____________________

E mail _____________________________Website___________________

Federal ID # _________________________________________________

Contact Name & Title___________________________________________

Amount of Request____________________________________________

Purpose of Request____________________________________________

___________________________________________________________

Current Organization Operating Budget____________________________

Percent of the budget spent on administrative expenses________________

Percent of the budget spent on programs___________________________

Percent of budget spent on fundraising ____________________________

Budget for Program/Project to be Funded___________________________

Total Support/Amounts Already Committed for Project________________

Total Support/Amounts Pending for Project_________________________

Is your organization a 509 (a) (3) Supporting Organization ____________

If Yes, Please indicate if you are a Type I, Type II or Type III (please circle) and

Explain _____________________________________________________