The Tom & Frances Leach Foundation, Inc.

Grant Application

Please have all pertinent information needed for this application available before starting.
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Contact Information



(if different)
Organization Information

501(c)(3)?

$

(list any other organizations in the area with a purpose similar to this organization)
(indicate the geographical area and population this organization serves)
Proposal Request

$
$
%
to

(describe the project or program for which funds are being sought and the need the project intends to address)
(describe the plan by which the results of this project will be determined and evaluated)
(describe the item or items needed and the respective costs, the components of the drive and the separate dollar goals)
(indicate additional sources from whom funds for this project are being sought)
(list major sources and levels of support of the past two years)
Financial Information

$
$
Organization's Audit
Organization's Tax Document
Required Documents

Please attach the appropriate document for each of the following items. Be aware that the maximum size of all documents combine must be under 25 MB.

The only accepted filetypes are; .pdf, .doc, .docx, .txt, and all image types (.jpg, .png, etc.).








Signed Statement:



Please verify that all the information is correct before submitting this application!


Upon submission an acknowledgment letter containing the filled out application and all uploaded documents will be emailed to the director email and contact email (if supplied).

Please review the application and documents for correctness and keep for your records.

If an email is not received within one hour of submission or if any information appears incorrect please reach out to the Grant Coordinator by email: leachfoundation@midconetwork.com or by calling 701-255-0479.