Type of organization:
Name that appears on you banking information (if different from above):
Mailing Address of Organization
Are you seeking funding for an ongoing program or a one-time event?
Details of Program/Event
What is the primary focus of your program/event?
Education and literacy
Health and wellness
Please provide a general description of your program/event, including the number of people the program will benefit, and how you will use the funding?
If the primary focus of your program/event was classified above as “other”, please provide additional details and explain why Fission should invest in your initiative.
Please indicate the amount of support you are seeking
How much of the total budget of your event/program will this request cover?
Are you seeking other sponsors?
Have you talked to anyone from Fission about this program/event?
If so, please list their name.
If you have a budget or other files you’d like to include, please do so.