FRIENDS of Iowa Civil Rights Fiscal Agent Request

Organization Information

* Organization

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Email Address

Contact Information

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Email Address

Funding Information

* What is the purpose of the grant funding? Include a concise overview of the project, the amount of the request, what and how the money will be used and a detailed budget.

You may attach a Word or PDF document below.

Attachment

* FRIENDS accesses a 10% administrative fee to any agency or organization in which it serve as fiscal agent.

I acknowledge that I have been informed and agree to pay the administrative fee.

* Indicates Response Required