Peter C. & Emajean Cook Foundation

Special Accommodation Grant Request

Capital Addendum with Operating Grant Request

This form is to be used only with permission. It will supplement our Standard Grant Request Form for those rare occasions where the Board agrees to consider both an operating and a capital grant in the same year.

Date of application:	Click or tap here to enter text.

Organization Information

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Name of Organization	EIN #
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Campaign Name	Campaign Total
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Estimated Timeline for Capital Campaign	Website

Proposal

Provide a 2-3 sentence summary of the request and the project summary. (Character limit 664)

Please attach drawings, estimates and naming opportunities, where applicable. Electronic files are preferable.

Note:

The foundation may fund up to 10% of a project, but the grant is contingent until the campaign attains 75% of goal. Most capital projects are funded with multi-year grants.

Budget

Dollar amount requested:	$Click or tap here to enter text.
Percentage of total:	Click or tap here to enter text.
Commitments to Date
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Five largest funding commitments and corresponding dollar amounts:

Endowment Fund Balance, if any	$ Click or tap here to enter text.

Square Foot (if building project)	Click or tap here to enter text.
Estimated cost per square foot (if applicable)	$ Click or tap here to enter text.

Feel free to attach details of calculation.

Explain your Campaign Timeline. Where are you relative to your timeline and the campaign goals? Project implementation plans? (Character limit 747)

Does the organization receive non-philanthropic revenue related to this project? Please describe and give an estimated percent of operations or project cost covered by these sources. (Character limit 747)

Authorization and Agreement

Name and title of person submitting Application	Click or tap here to enter text.

If you receive funding under this Grant Request, you agree to host the Foundation for a tour and project review within in 12 months of funding.