Application for Community Support From Michelin North America
1. Please review support core focus and guidelines 2. Complete this application with appropriate attachments 3. E-mail completed form with appropriate attachments Note: Please allow 90 days for processing of your request for funding New applications must be made each year for annual events Name of Organization: Non-Profit Tax ID#: Address: City: Program Contact: State: Contact Phone: Zip: Date:
1. This request is for (Check appropriate box and amount) Corporate/Facility Gift Event Sponsorship Multi-Year Pledge In-Kind Gift Amount: Amount: Amount: Requested Gift:
Personnel Resources: Board Member, Volunteers, etc. (please indicate):
2. Description of Organization. Include a brief summary of your organization which outlines: Purpose of program Population and audience served How funds from Michelin would be used
3. What date does the request need to be fulfilled?
4. Has Michelin supported this event or program in the past? If yes, when and what activity?
Yes
No
© 2006 Michelin North America, Community Relations, P.O. Box 19001, Greenville, SC 29602-9001 www.michelin-us.com