The Christensen Fund

Pre-Proposal for United States-Registered Organizations

Please complete all of the following questions.  We ask that you do not skip any questions as these are all important in order for our program team to review and decide on your request.

What geographic area are you applying under? Please mark up one area only.

Proposed Grantee Organization

1.       Name of Organization to Receive the Grant  

2.       Legal Name

3.       Also Known As Name (Optional)

4.       Address of Organization's Main Office  

5.       City, State (Abbreviation, please) and Zip Code

6.       Main Organization's Phone

7.       Main Organization’s Fax  

8.       Organization's E-mail Address  

8.        Website Address (if available)

9.        Organizational Background   -   Please provide information on your mission,  primary activities, governance and typical sources of financial support and/or major donors. (up to 200 words)  

10.    Organization's Fiscal Year End (Month/Day)

11.    Total  Annual Organizational Budget (For current year)

12.    US Tax ID Number - Please provide the US Tax ID Number for the proposed   grantee organization.  

13.    IRS Tax Status - Please type in the tax status for your organization. Is it a 509(a)(1), 509(a)(2), 509(a)(3)  or Other (please specify)?  

Applicant Contact Information

1.    Contact Prefix   (Dr., Mr., Ms., etc.)

2.      First Name and Last Name

3.      Position Title  

4.      Your Office Address  

5.      City, State and Zip Code

6.      Country  

7.      Your Phone and Extension (If applicable)

8.      Your Fax  

9.      Your E-mail  

10.  Preferred Means of Contact?  (Email, Telephone, Fax, Post)

 Your Proposed Project

1.      Today's Date  

2.      Country or Region That Project Would Benefit  

3.      Amount Requested from the Christensen Fund (Current Maximum: $200,000)  

4.      Total Project Budget  

5.      Length of Project in Months (Current Maximum: 24 months) - Please enter the term in whole months; example: enter 12 for a year-long project.  

6.      Proposed Project Start Date - What date would you require to receive this grant?  

7.     Proposed Project Title - What is your project or program called?  

8.      Tell us about the Project, Purpose and Goals, and Why the Project Is Important (up to 400 words)  

9.      Grant Activity - What activities would you like us to fund? (300 words or less)  

10.  Connection to the Christensen Fund's Grantmaking Focus - Please describe why this project strengthens bio-cultural diversity and healthy relationships between land and people, culture and nature. (See grants list on the Grants Overview section of our website.)  

12.  Other Funding Sources towards this Project - Please indicate whether none, pending or awarded, and amount.  

13.  Main Project Personnel and Relevant Experience (up to 100 words)  

14.  Additional Information - Space for any additional information. (up to 100 words)  

15.  How did you find out about the Fund?   -  Please let us know if by mailing, online search, foundation directory, or if referred, by whom, etc.  

 Last Revision Date: 03/14/08