The Zhubin Foundation - Printable Application for Funding Form

If your organization is interested in requesting funding from The Zhubin Foundation, kindly complete the following application form.
The completed form and supporting documents should be mailed to:
The Zhubin Foundation, 496 avenue Wood, Westmount, QC, H3Y 3J2, Canada
Or e-mailed to:info@zhubinfoundation.com

General Information:

Name of Organization
Contact Person, Position/Title
Address
Telephone
Charitable Registration Number
Year the organization was founded

Mission:

What is the mission of your organization?
Describe the goals of your organization and the programs which meet those goals.
Describe your client base.

Funding Request:

Is this request for funding for a new program/service or for an already existing one?
What is the amount of funding requested?
How will the funds from The Zhubin Foundation be used?
What are the goals and objectives of the program/service for which funds are requested?
How many participants will directly benefit from the program/service and who is the target population?
Describe the specific activities and how the program/service is delivered?
How will the success of this program/service be evaluated?
Please provide a detailed budget for the program for which funds are requested?
How is the program administered?
What other sources of funding do you receive?
How did you hear of The Zhubin Foundation?
Please attach a copy of your current years budget.
Please attach a copy of the most recent copy of your audited financial statement.
Please provide any other information you would like us to consider.