WESLEY AND IRENE MANSFIELD CHARITABLE FOUNDATION 1000 W 13TH ST. TAMA IOWA 52339 ORGANIZATION'S APPLICATION FOR GRANT GENERAL GUIDELINES A)GRANTS ARE ONLY MADE TO NON- PROFIT ORGANIZATIONS OR GOVERNMENTAL ENTITIES. B)THE FOCUS OF THE MANSFIELD FOUNDATION IS TO SUPPORT THE COMMUNITIES OF BELLE PLAINE AND TAMA IOWA AND ALBION NEBRASKA. C)APPLICATIONS NEED TO BE RECEIVED BY MAY 15 TO BE CONSIDERED FOR ACCEPTANCE. D)IF AWARDED, GRANTS ARE GENERALLY DISBURSED IN JULY OF EACH YEAR. PART 1: INFORMATION ABOUT THE APPLICANT ENTITY NAME:______________________ ADDRESS:______________________ CITY, STATE ZIP: ______________________ CONTACT NAME: ______________________ PHONE: ______________________ EMAIL: _____________________ A)IS THE APPLICANT A GOVERNMENTAL ENTITY? YES / NO B)IS THE APPLICANT A NON-PROFIT ORGANIZATION? YES / NO IF YOU ARE A NON-PROFIT, ATTACH A COPY OF YOUR IRS DETERMINATION LETTER OR A COPY OF YOUR MOST RECENT FORM 990. IF YOU ARE A NON-PROFIT, ATTACH A LIST OF YOUR GOVERNING BO

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