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