PAUL PALANK MEMORIAL FOUNDATION PRE-APPLICATION
Are you an IRS 501 (c) (3) ?
If you have answered YES to the above question, please continue with the Pre-application

If you have answered NO to the above question, we thank you for your interest in Paul Palank Memorial Foundation
and invite you to visit other related organizations on the Links page of this site in order to assist you and your
organization with alternate funding opportunities.
ORGANIZATION INFORMATION
Name of Organization
Organization Head
Briefly describe your organization and the services it provides.
Physical Facility Address
Mailing Address (if different from above)
Telephone Number - (xxx) xxx-xxx
Fax Number - (xxx) xxx-xxx
E-mail address
Website URL
Annual Organization Budget in $ Dollars
PROJECT INFORMATION
Project Name (This is how you will be known to us on all correspondence.  Please make note of the exact entry.)
Project Contact Name & Title
Telephone Number - (xxx) xxx-xxx
Fax Number - (xxx) xxx-xxx
E-mail address
Please provide a brief description of the project/program for which you are seeking funding including purpose of
request and program area.
How does your project relate to the Paul Palank Memorial Foundation Mission Statement?
Amount Requested In $ Dollars
How are funds to be spent?
Age of Population?
This project is a(n)
Number of people to be served
I hereby certify that I am authorized by this organization to submit this Pre-application and that I am an IRS 501 (c) (3)
organization with a current determination on file and that the organization has not received notice from the IRS of any
proposal, threat, or suggestion to revoke or modify this determination.  My electronic signature below affirms this
certification and authorization..