2024 Liberty Foundation
Grant Request Form

Contact: Contact

This platform does not provide a way to save your application, so you must be prepared to fill it out and upload all required documents at once.

Organization's Profile

Organization's Legal Name

Employer Identification Number

Address

Contact Person

Contact Person's Email

Contact Person's Phone #

Executive Director or CEO

List of the members of the Board of Directors

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Organization's Mission

Briefly describe the organization’s main services

Number of participants served annually and their ages

Organization's Total Budget

Brief description of volunteering program(s), if applicable. Include the name, phone # and email of the contact person.

How does your organization put into practice the principles of diversity, inclusion, and equity?

Briefly describe one significant achievement that the organization had during the past year.

Previous Grants

Has the organization received a grant/donation/sponsorship from Liberty PR/Liberty Foundation in the past?

YES

If you received a donation for 2024 (delivered in December 2023), summarize the results achieved or the implementation stage of the program/project for which the donation was granted.

Submit relevant supplementary information on this program funded by Liberty Foundation. Please, include an overview on how the grant was used or is being used. Ex. Materials - $1,000 / Food - $2,000. *It is not necessary to present receipts.

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2024 Proposal

Program/project name

Estimated start date

Estimated end date

Total number of participants who will be impacted DIRECTLY this program/project and their ages

Program/project summary, including the need it addresses.

Include the main objective of the program/project, what evaluation method will be used and in what period it must be achieved. Ex. Objective: 90% of participants will improve their academic performance / Evaluation Method: Participant's grade report / Period: 6 months

Amount of funds requested

Upload a general estimated budget for the proposed program/project

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Are there additional funds for this program/project? What is the source of those funds?

Documents and Certifications

Certification of Incorporation (Only for organizations that have not receive funds from Liberty Foundation)

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Good Standing Certificate

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Federal Tax Exemption (501 c3)

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W-9

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Only for Puerto Rico based organizations. Tax exemption letter from "Departamento de Hacienda". (Sec. 1101.01)

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I hereby certify that all the information provided in this Grant Request is correct and that I am authorized to represent the aforementioned organization for these purposes.

Your Signature

Your proposal was successfully submitted.Thank you!

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2024 Liberty Foundation Grant Request Form

2024 Liberty Foundation
Grant Request Form