GRANT APPLICATION
Date of application:
Credit Union/Organization Name:
Contact Person:
Address:
City/State/ZIP:
Telephone Number:
Fax Number:
Purpose of Grant:
Grant Request Amount:
Please check one:
Community Investment
Credit Union Development
Education
Disaster Relief
Signature:
Title:
Date:
Date Received: Amount Approved:
Date Reviewed: Type of Grant:
Comments:
Print and Return this form to:

Joe Guilfoy
Indiana Credit Union Foundation
P.O. Box 50425
Indianapolis, IN  46250-0425
800-285-5300
Fax: (317) 594-5301