Application in Legal

							                               Grant Application

Organization Information


Date of Application:

Legal Name of Organization:

Address:

City:                                   State:                       Zip:

Telephone:                       Fax:

Email:

Executive Director Name:                Telephone:

Grant Contact Name:                     Telephone:

Organization Description
Provide 2-3 sentences regarding your organization, including a summary of
mission and objectives:



Age Group Served: (check all that apply)
  Babies/ Toddlers (under 5)                     Youth (5-18 yrs.)
  Young Adults (19-29 yrs).                      Adults only (30-60 yrs.)
  Aging/Elderly/Senior Citizens

Focus Area
Please check which Albertsons focus area your request falls under:
           Hunger Relief         Health                  Nutrition

Program Description


Program Title:

Amount Requested: $

Total Program Budget: $
Provide a brief summary of the program’s activities and why they are needed in
your community.


Please describe how the program will have a positive impact in the community.



Volunteers
Are there any opportunities for volunteer involvement in association with this
grant/ project? If yes, please describe:



Grant History
In the past 12 months, have you received a grant from SUPERVALU or
Albertsons?
                                   Yes      No

If yes, please list the grant date, program title, grant amount and brief program
description for each grant received (in the past 12 months).


Grant Date:                                     Grant Amount:

Program Title:

Program Description:



Please include the following documents with this application form:
    A completed W-9
    An IRS copy of your organization’s 501(c)(3) letter if you are a nonprofit
    Any additional information that describes how the donation would benefit
      your organization (e.g., news clippings, no more than 2 sample photos,
      etc. Please do not provide videos/DVDs, event t-shirts, giveaways, etc.)
    Schools or units of government should submit your request on letterhead

If located in Southern California or Southern    If located in Idaho, Montana, Oregon, Utah,
Nevada, please send your application to:         Washington and Wyoming, please send your
                                                 application to:

Albertsons Communications and Public Affairs     Albertsons Communications and Public Affairs
Department,                                      Department,
1421 S. Manhattan Blvd.,                         250 Park Center Drive
Fullerton, CA 92831                              Boise, ID 83726


  Requests can take up to 6 weeks for review. If you are applying for an event, please
           send your request at least 8 weeks in advance of the event date.