Organization Name
Type of organization:
Registered non-profit
Registered charity
Name that appears on you banking information (if different from above):
Mailing Address of Organization
Phone Number
Contact Person
Are you seeking funding for an ongoing program or a one-time event?
Program
Event
Details of Program/Event
What is the primary focus of your program/event?
Youth initiatives
Education and literacy
Health and wellness
Community development
Cultural programming
Other
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?
Yes
No
Have you talked to anyone from Fission about this program/event?
Yes
No
If so, please list their name.
If you have a budget or other files you’d like to include, please do so.
Submit