Organizational Information Existing Contact Organization Name * Legal Name Street Address * Street Address Line 2 City * Postal Code * State/Province * District/County Country * United States Phone Number * Email * Website * Facebook Twitter Organizational Contact First Name * Last Name * Job Title * Upload Image Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. Phone Number * Email * Financial-Grant Information Date of incorporation: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year18671868186918701871187218731874187518761877187818791880188118821883188418851886188718881889189018911892189318941895189618971898189919001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018 Total organization budget for current year * Grant Amount requested by FBT: * Grant request is for: * Income Generation Solution Women Empowerment Solution Youth Development Solution Healthcare Solution Economic Development Solution Other Other Program/project title for the Grant Requested: * FBT Grant Requirements Is your organization tax exempt in your country of operation? * Yes No If no, please explain further Is your organization authorized to accept foreign funds (american dollars) in your country of work? Example FCRA authorization in India, etc. * Yes No If no, please explain further Is your organization involved with or support political activities? * Yes No If yes, please explain further Is your organization involved with or support religious activities? * Yes No If yes, please explain further Has your organization, your current or past staff, your current or past Board of Directors or volunteers ever been involved in a law suit, conviction or financial misdemeanor? * Yes No If yes, please explain further Please attach audited financial statements for the last program year or budget for upcoming year Files must be less than 5 MB.Allowed file types: gif jpg jpeg png pdf doc docx xls. Please attached By-Laws, List of Board of Directors, Organization mission, vision & values and/or other relevant legal documentation, as needed. Files must be less than 5 MB.Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx. Can the project grant funds be provided over a year or two? * Yes No If no, please explain further Does your organization receive funding from another organization or foundation like FBT? * Yes No If no, please explain further FBT provides financial support to reimburse vendors. Can your organization identify vendors to pay this grant money? * Yes No If no, please explain further Please provide additional information reading your staff. # Employees and Total Salary/Personnel Expense * Please share any additional information that would assist FBT in making the grant decision. Past major achievements, individuals/organizations who can serve as reference, measures of success for this grant request, etc.