Please provide the following for proof of eligibility:
ORGANIZATION’S OFFICIAL NAME:
PHYSICAL ADDRESS IN TEXAS:
MAILING ADDRESS:
ORGANIZATION’S TELEPHONE NUMBER:
WEBSITE ADDRESS:
ORGANIZATION’S MISSION STATEMENT:
ORGANIZATION’S CONTACT PERSON:
JOB TITLE:
BUSINESS TELEPHONE NUMBER:
CELL PHONE NUMBER:
EMAIL ADDRESS:
Please review all above information to ensure it is correct and that your
organization’s 501(C)(3) tax-exempt status determination letter from the IRS is
attached before submitting.
Submit completed form to [email protected].
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