Futures Foundation

Grant Request Form

Name (required)

Date (required)

Address (required)

The grant would be used for (required)

Grants are awarded to fund the needs, wishes and dreams of those served by MORC. Please use as much space as necessary to outline the need for the request. Please answer the following questions in your narrative: What is the amount of monthly assistance remaining for personal items after expenses are paid? Does the individual live in a licensed home or on their own in an apartment or other home? What other resources can be used to help with expense and has a formal quote or estimate been obtained? Has a physician or other professional made a recommendation for the device or item requested?

Phone Number (required)

Dollar Amount Requested (required)

Email

Name of Submitter (required)

Number of Submitter (required)