REQUEST PRE-PRINTED APPLICATION FROM GILLILAND FAMILY FOUNDATION: SANDRA GILLILAND 500 S. TAYLOR, LB# 249 AMARILLO, TX 79101 INFORMATION REQUIRED ON THE FORM INCLUDES BUT IS NOT LIMITED TO: GENERAL ORGANIZATION INFORMATION, AMOUNT REQUESTED, DATE FUNDS ARE NEEDED, INFORMATION REGARDING PRIOR FUNDS RECEIVED FROM THE FOUNDATION, USE FOR THE REQUESTED FUNDS, ACCOMPLISHMENT GOALS FOR THE REQUESTED FUNDS, FUNDS RAISED TO DATE REGARDING THE PROJECT, AND A COPY OF THE ORGANIZATION'S 501(C)(3) DETERMINATION LETTER.

ORGANIZATION MUST BE EITHER A QUALIFIED 501(C)(3) ORGANIZATION OR USE OF EXPENDITURES MUST BE USED EXCLUSIVELY FOR PURPOSES DESCRIBED IN IRC SECTION 170(C)(2)(B). ALSO, APPROVED APPLICATIONS MUST MEET THE RESTRICTIONS ESTABLISHED IN THE ORGANIZATION'S CHARTER.