Contact Information Form

If you have received PRIOR funding from the Lockhart Vaughan Foundation, you must complete this form. New applicants must submit a letter of intent.

Has your organization ever received a grant from the Lockhart Vaughan Foundation? *

No, I am a first time grantee
Yes, I am a prior grantee

Organization Information

Organization Full Name *

Federal Tax ID (EIN) *

Bill.com Payment Network ID (PNI)

Website / URL

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Fiscal agent (if any)

Organizational Leader's Information

Organizational Leader Name *

First

Last

Organizational Leader Title *

Organizational Leader Email *

Organizational Leader Daytime Phone *

Proposal Contact's Information

Proposal Contact Name *

First

Last

Proposal Contact Title *

Proposal Contact Email *

Title Title Name

Proposal Contact Daytime Phone *