Application

First Name*

Last name*

Email*

Organization*

Organization Website

Tax ID/EIN

Street Address*

City

State*

Zip Code*

Describe your specific needs*

Briefly describe you organization and mission.

Approximately how many people will benefit from this assistance?

How will this support impact your program and community?*

Have you received assistance from Shindig Foundation before?*

Yes

No

Certification

I certify that the information provided is accurate and that our organization is a qualified 501(c)(3) nonprofit.

I understand that if approved, we may be asked to provide photos and testimonials for Shindig Foundations' promotional use.