Community Request Form Organization DetailName of organization:Charitable registration/business number (as provided by the Canada Revenue Agency):What is the primary focus of your organization?Arts & CultureEducationEnvironmentHealthRecreationHuman and Social ServicesChild/Youth Team SponsorshipEvent SponsorshipOtherWhat is the geographic scope of your organization?Local or CommunityRegionalProvincialNationalIf 'local or community', please tell us where:Please give a brief history of your organization:Please list your organization's goals and achievements:Please give a description of the clients or groups served:Did a Tacora employee refer you to this application?YesNoIf yes, please provide details:Primary Contact InformationFirst NameLast NamePosition in organization:Telephone number and extension:Email:Organization website address:Address of OrganizationAddressSecond address lineCityState/ProvinceRequest DetailsFor reference purposes, please provide a name for this project, program or campaign:Please describe your project, program or campaign. What do you plan to do?What is the geographic scope of this project, program or campaign?Local or CommunityRegionalProvincialNationalWhat is the total budget?Money raised to date:What amount are you requesting from Tacora?What are the predicted outcomes of this project, program or campaign, and how will you measure whether you have been successful in achieving those outcomes?How do you plan to recognize our involvement and support?Has your organization received funding from Tacora in the past?YesNoIs yes, please provide details:Submit