Fremont County Grant Request

Name of Organization*

Organization EIN*

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address*

Same as Physical Address

Street Address Address Line 2 City State ZIP Code

Contact Person*

First Last

Email*

Phone Number*

Vision and Mission of Organization*

Brief Description of Key Programs*

The vision of UnbridledACTS is simply to love people to life. In order to approve grants, we look for organizations who have a unique expression of this vision. Please briefly describe how your organization “loves people to life.”*

Purpose for Grant*

Requested Amount*

Attach supporting documents

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Grant Request

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