Erion Foundation

P.O. Box 732 GRANT APPLICATION

Loveland, CO 80539

Ph. 970-667-4549        Date:

Organization Name:

Contact Name: Title:

Street Address:

Mailing Address:

City: State: Zip:

Telephone: ( ) Fax: ( )

Email Address: Web Site URL:

Amount Requested: Type: Program Area: Basic Needs

Operating Education

$ Capital Culture & Community

Health & Welfare

Geographic Service Area	Number of People (Clients) Served in Past 12 Months
Loveland
Larimer County (excluding Loveland)

Is your request for our geographic area? Yes No

How would these funds be used (briefly describe in the space allotted)?

Please include:

A copy of your organization’s 501(c)(3) designation letter

Page one of your organization’s most recent IRS Form 990

Person filling out this form:

Name: Title:

Please do not send extra materials – If we have questions we will call.