Request For Funding | Quad City Parrot Head Club

Your Organization *

Address *

City *

State *

Zip *

Phone *

Your Email *

Tax Exempt Status *

Federal ID *

Contact Name *

Title *

Website

QCPH member sponsoring this request

Brief History of Your Organization

Brief description of the project or program for which you are seeking funds or other support

Who will be served by this project? Please include number of persons, state or county of residence, and other characteristics, such as age, income, or other qualifying demographics:

Amount Requested *

Total Project Value *

What are your major funding sources? *

What percentage of your revenue is spent on administrative costs? *

If your organization has a national, state, or regional affiliation, what percentage of funds raised locally is passed on to the organization? *

Please describe any funding campaigns that may occur in the next 24 months *