ORGANIZATION INFORMATION Name of Organization * EIN/Tax ID # * 501(C)(3) Status (since) * Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Website http:// Name of Contact * First Name Last Name Title or Relationship to Organization * Email * PROGRAM INFORMATION Program or Event Name * Purpose of Support * How will the funds raised for the program be used? How will a ProShine donation assist your program? * Area/Community the Program will Serve * Estimated Number of People Served * Date of Program or Event MM DD YYYY
