Grant Type

Organization Requesting Grant

Name of Chapter, Colony, or Housing Corporation and Host Institution (if applicable):

President's Name:

President's Email Address:

Treasurer's Name:

Treasurer's Email Address:

Program Name:

Amount of Grant Request:

What date do you need the funds by?:

YYYY

How many people are expected to attend or directly benefit from the program?:

What are the goals/objectives of the program?:

How will this program advance the educational and charitable mission of Phi Kappa Theta?:

How will you evaluate the success of the program?:

Total Budget:

Grant Requestor's Name:

Grant Requestor's Position:

Grant Requestor's Email Address:

Grant Requestor's Preferred Phone Number:

(###)

###

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Please email any supporting documents you would like the Foundation to consider when evaluating this grant request to grants@pktfoundation.org.

PHI KAPPA THETA NATIONAL FOUNDATION, INC.