Herons Give Back Grant Application

Nonprofit Organization

Please provide this information to introduce your nonprofit organization.

Question Title

* 1. Nonprofit Information

Organization Name

Address

City

Zip

EIN

Contact Name

TItle

Email

Phone

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* 2. Is nonprofit listed above a tax-exempt 501(c)(3)?

Yes

No

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* 3. In what year was the nonprofit organization established?

Question Title

* 4. Organization's Mission

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25% of survey complete.