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 Year18681869187018711872187318741875187618771878187918801881188218831884188518861887188818891890189118921893189418951896189718981899190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 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.