Organization:     

Physical Address:
                  

Mailing Address (if different from above):
                  

Phone:            
Fax:              
Email:            
Website:          

Mission:
                  

Scope:             Local State National International

IRS Classification:    501(c)(3) 501(c)(6) Other    (if Other, please specify)

Number of Employees:
     Full Time:   
     Part Time:   
     Volunteers:  

Organization type:  Arts Educational Environmental Government Human Services Individual Religious Scientific Sports Youth/Recreation Other    (if Other, please specify)

Operating Budget   $0 - $100,000 $100,001 - $400,000 $401,000 - $1,000,000 $1,000,001 - $3,000,000 $3,000,000 - $5,000,000 > $5,000,000

Individual completing this form:
    Name:         
    Phone:        
    Email:        
    Title:        

Description of assistance needed:
          

How did you learn about FRESC?
                
 

If you have any questions regarding this application, you may contact FRESC at this email address: agency_apply@frontrangeesc.org or view other contact information on the Contact FRESC page.