JiJi Foundation

Application Cover Sheet

Basic Organization Information

Organization Name: Click here to enter text.

Fiscal Agent (if appropriate): Click here to enter text.

Address: Click here to enter text.

City, State, Zip: Click here to enter text.

Country: Click here to enter text.

Tax Identification Number (EIN or RFC): Click here to enter text.

Is your organization in compliance with new IRS regulations regarding automatic revocation of tax exempt status? (see http://www2.guidestar.org/rxg/update-nonprofit-report/nonprofit-resource-center-automatic-revocation-of-tax-exempt-status.aspx?hq_e=el&hq_m=718353&hq_l=10&hq_v=5cf6655d03)

Yes	No

B. Contact Information

Executive Director: Click here to enter text.

Executive Director email address: Click here to enter text.

Contact Person (other than Executive Director): Click here to enter text.

Contact Person email address: Click here to enter text.

Organization Website: Click here to enter text.

Organization Phone Number: Click here to enter text.

Other contact number (if needed): Click here to enter text.

C. Proposal Information

Proposal Title: Click here to enter text.

Amount Requested: Click here to enter text.

Date Submitted to JiJi Foundation: Click here to enter text.