Please submit requests to be considered for our Spring meeting by May 1, and by November 1 for our Fall meeting.
Please complete the following:

Note: All fields marked with an asterisk(*) are required.

Date of event, if applicable 
* Organization Name         
* 501(c)(3)                       
* Contact Person Name      
* Contact Person's Title      
* Address:                         
* City:                              
* State:                            
* Zip:                               
* Telephone Number       
   Fax Number                   
* E-Mail Address               
* Counties or Areas Served 
* Amount Requested           
* Total Project Cost            
Lori Selissen, Executive
Phone: 920-490-5309
[email protected]
* Please describe the purpose for this contribution request.
  (1500 character limit)

* Describe the project for which funds or services are being sought.
  (1500 character limit)

* Give a brief explanation of your organization, its objectives, population served, and geographic area of service.
  (1500 character limit)

Are any Little Rapids Corporation associates involved in the fund drive? Organization? If yes, provide names.
  (1500 character limit)
Please attach any additional supporting documentation.

5MB limit
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