REQUEST FORM FUNDS

1. REQUESTING ENTITY INFORMATION

NAME / BUSINESS NAME *

TAX EXEMPTION *

COUNTRY *

ADDRESS *

ZIP CODE / POST CODE *

CITY *

MISSION *

WEBSITE / SOCIAL NETWORKS *

 

2. CONTACT INFORMATION/PROJECT MANAGER

NAME *

SURNAME *

TITLE *

EMAIL *

PHONE *

 

3. PROJECT SUMMARY

NAME OF THE PROJECT *

SECTOR *

PLACE *

OBJECT OF THE PROPOSAL (MAX. 360 CHARACTERS, INCLUDING SPACES) *

METHODOLOGY/ARTISTIC TOOL USED *

DIRECT BENEFICIARIES *


HUMAN RESOURCES

NUMBER *

FUNCTIONS *

OBJECTIVES AND RESULTS ANTICIPATED *

PARTNERS OF THE PROJECT (IF APPLICABLE) *

DURATION FORESEEN *

 

4. BUDGET

GENERAL BUDGET IN EUR OR CHF *

SUPPORT REQUESTED TO ALTA MANE IN EUR OR CHF *

COSTS ALREADY COVERED IN EUR OR CHF (IF APPLICABLE) *

OTHER DONORS (IF APPLICABLE) *

 

5. EXPLAIN THE REASON FOR REQUESTING SUPPORT FROM FONDATION ALTA MANE AND DESCRIBE HOW THE PROJECT IS PERTINENT TO THE FOUNDATION’S FOCUS* (MAX. 360 CHARACTERS, INCLUDING SPACES)

*

* Mandatory fields

SUBMISSION OF THIS FORM DOES NOT BOUND IN ANY WAY FONDATION ALTA MANE. I HAVE READ AND AGREE TO THE GENERAL PRINCIPLES