Selma Burkus Investments Grant Program

Application Form

Thank you for your interest in the Selma Burkus Investments Grant Program. Our mission is to provide support to organizations, and anyone with a project that needs funding. We particularly focus on helping students, disabled individuals, the unemployed, people in debt, retired persons, and business owners who are facing challenges and have a clear vision for their future.

Please complete this simple application form.

Contact Information

Full Name / Organization Name:

Email Address:

Phone Number:

Current Address (for individuals) / Business or Organization Address (for organizations):

About You / Your Organization

Please check all the categories that apply to you or your organization's current situation:

Your Project or Need

Briefly describe the project or important need for which you are requesting funds. Be specific about how the money will be used and why it's important to you or your organization.

(For example: "Our non-profit is seeking funds to develop a new after-school program for at-risk youth," or "I am a retired individual who needs help with medical bills and home repairs.")

Fund Request

Amount of Funds Requested:

Have you applied for or received funding from other sources for this project/need?

Yes

If yes, please provide details:

How did you hear about us?

Please let us know how you found out about the Selma Burkus Investments Grant Program.

Friend or Family Member's Name:

Declaration

By submitting this form, you certify that the information provided is true and accurate to the best of your knowledge. You understand that the Selma Burkus Investments Grant Program will use this information to evaluate your request.