The Church Mouse Thrift Shop, Inc.
78 Arrow Road, Suite G
Hilton Head Island, SC 29928
843-785-2322

2017 Grant Application

Name of Organization or Group

Mailing Address

Mailing City

Mailing State

Mailing Zip

Physical Address

City

State

Zip

Contact Person

Phone #

Fax #

Contact email

Organization's Mission Statement

Amount Requested

Describe Purpose for Which Funds Will be Used

Other Sources of Income and Recently Received Grants: (List all organizations including federal, state, county and local funds)

PLEASE UPLOAD REQUIRED DOCUMENTATION
*Proof of federal income tax exemption status as a 501C3 organization.
*Financial statement for prior fiscal year to include actual income received and expenses.(P&L and BS)
*Budget and financials for current fiscal year and budget for next (2016) fiscal year.
*List of current Board of Trustees/Directors and Principal Officers of organization requesting grant.

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