About your organizationWhat is the name of your organization?* Are you a registered charity?* Yes No If you are a charity please provide your registration numbers. What location does your organization serve?* What is the mission of your organization?*Request TypeWhat are the requested funds being used for?*What kind of request are you making?* Cash (charitable financial contribution) In-kind (specific product you believe the company can provide) Do you have other funders? If so, who are they?*Please explain how your request aligns to BluEarth's giving priorities (environment, education, community building)*About the RequestPlease describe what you are requesting*If your request involves an event, please identify all relevant dates.What is the target audience of your organization / event?*What are the direct outcomes or impacts of your organization / event?*What is the overall budget?*What is the dollar amount of the cash or description of the in-kind items you are requesting?*How will BluEarth’s involvement be recognized?*Contact InformationPrimary contact person at your orgainzation* First Last Primary contact persons's title. Address* Street Address City State / Province / Region ZIP / Postal Code Country CountryPhone*Email* Website Please attach any relevant documents Drop files here or Select files Max. file size: 50 MB. EmailThis field is for validation purposes and should be left unchanged.
