Contact Name
Is this organization exempt from payment of income tax?
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Is this organization affliated with a state/national organization that provides funding?
Does this organization service outside of Wharton, Matagorda, and Colorado counties?
Provide the purpose of the requested funding including amount requested and specifics on how the funding will be use.
Are you willing to accept funding before or after your event?
List any other sources of funding that may be received to fulfill the purpose listed above.
The information contained in this statement is for the purpose of obtaining funding from the WCEC Charitable Fund, Inc. on behalf of the undersigned.  Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is true and complete and that the WCEC Charitable Fund, Inc. may consider this statement as continuing to be true and correct until written notice of a change is provided.  The WCEC Charitable Fund, Inc. is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein.  Additional documentation may be requested as needed. 

I understand that checking this box and typing my name in the field provided below is my electronic signature.