APPLICATION

(For Requests of $5,000 or less)

click here to return to: Standard APPLICATION

The van Löben Sels/RembeRock Foundation accepts grant applications throughout the year. The request for funding must be consistent with the mission and guidelines of the Foundation. Please follow the format below:

1. Organizational information:

   1. Name of organization: ____________________________________________
      Address: _________________________________
      Phone #: ______________________
      Website: _____________________________

   2. Executive Director: _____________________________

   3. Contact Person: _____________________________

   4. Email and phone of contact person: ____________________ / _______________

2. Description of organization ─ who you are and what you do:
   (1 page maximum)

3. Amount requested (this form is for requests of $5,000 or less) and for what purpose:
   (1 page maximum)

4. Attach current year organizational budget.

5. Attach current year project budget (if applicable).

6. List grants received from the van Löben Sels/RembeRock Foundation over the past five years, including amount and purpose.

Required Attachments:

1. Documentation of tax-exempt status

2. Current roster of Board of Directors and affiliations

3. For a renewal grant, submit a year-end report (not to exceed one page) on the previous grant.

Miscellaneous:

1. Submit in readable size font (at least 12-pt).

2. No 2-sided printed/copied pages.

3. No videotapes, audiotapes, CDs.

4. No certified mail delivery.

5. Send “no signature required.”

6. Submit proposal signed by the Executive Director to:
   
   Ms. Toni Rembe, President
   van Löben Sels/RembeRock Foundation
   131 Steuart St., Suite 301
   San Francisco, CA 94105

Questions:

Call Dan Corsello, E.D. at (415) 512-0572, or
Gail Shuster, Program Administrator, at (415) 512-0500

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