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</div> <div class="field"> Name of the Organization *<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtName" type="text" id="txtName" class="name-input" placeholder=""/>   <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtSome" type="text" id="txtSome" class="no-input" placeholder="LEAVE EMPTY:"/> </div> <div class="field"> Address *<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtAddress1" type="text" id="txtAddress1" class="name-input" placeholder=""/>   </div> <div class="field"> Address<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtAddress2" type="text" id="txtAddress2" class="name-input" placeholder=""/> </div> <div class="field"> City *<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtCity" type="text" id="txtCity" class="name-input" placeholder=""/>   </div> <div class="field"> Zip Code *<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtZip" type="text" id="txtZip" class="name-input" placeholder=""/>   </div> <div class="field"> State<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtState" type="text" id="txtState" class="name-input" placeholder=""/> </div> <div class="field"> Country * <select name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$cmbCountry" id="cmbCountry" placeholder=""> <option value="Afghanistan">Afghanistan</option> <option value="Albania">Albania</option> <option value="Algeria">Algeria</option> <option value="Angola">Angola</option> <option value="Armenia">Armenia</option> <option value="Australia">Australia</option> <option value="Austria">Austria</option> <option value="Belgium">Belgium</option> <option value="Benin">Benin</option> <option value="Bhutan">Bhutan</option> <option value="Bosnia-Herzegovina">Bosnia-Herzegovina</option> <option value="Botswana">Botswana</option> <option value="Brazil">Brazil</option> <option value="Bulgaria">Bulgaria</option> <option value="Burkina Faso">Burkina Faso</option> <option value="Burundi">Burundi</option> <option value="Cambodia">Cambodia</option> <option value="Cameroon">Cameroon</option> <option value="Canada">Canada</option> <option value="Central African RPC">Central African RPC</option> <option value="Chad">Chad</option> <option value="Chech Republic">Chech Republic</option> <option value="Chile">Chile</option> <option value="China">China</option> <option value="Colombia">Colombia</option> <option value="Croatia">Croatia</option> <option value="Cyprus">Cyprus</option> <option value="Denmark">Denmark</option> <option value="Egypt">Egypt</option> <option value="El Salvador">El Salvador</option> <option value="Estonia">Estonia</option> <option value="Ethiopia">Ethiopia</option> <option value="Finland">Finland</option> <option value="France">France</option> <option value="FYROM">FYROM</option> <option value="Gambia">Gambia</option> <option value="Georgia">Georgia</option> <option value="Germany">Germany</option> <option value="Ghana">Ghana</option> <option value="Greece">Greece</option> <option value="Guatemala">Guatemala</option> <option value="Guinea">Guinea</option> <option value="Haiti">Haiti</option> <option value="Honduras">Honduras</option> <option value="Iceland">Iceland</option> <option value="India">India</option> <option value="Indonesia">Indonesia</option> <option value="Iran">Iran</option> <option value="Ireland">Ireland</option> <option value="Israel">Israel</option> <option value="Italy">Italy</option> <option value="Japan">Japan</option> <option value="Jordan">Jordan</option> <option value="Kenya">Kenya</option> <option value="Korea">Korea</option> <option value="Kosovo">Kosovo</option> <option value="Kyrgyzstan">Kyrgyzstan</option> <option value="Laos">Laos</option> <option value="Lebanon">Lebanon</option> <option value="Liechtenstein">Liechtenstein</option> <option value="Lithuania">Lithuania</option> <option value="Madagascar">Madagascar</option> <option value="Malawi">Malawi</option> <option value="Mali">Mali</option> <option value="Mexico">Mexico</option> <option value="Monaco">Monaco</option> <option value="Montenegro">Montenegro</option> <option value="Morocco">Morocco</option> <option value="Mozambique">Mozambique</option> <option value="Myanmar (Burma)">Myanmar (Burma)</option> <option value="Nepal">Nepal</option> <option value="Netherlands">Netherlands</option> <option value="Nicaragua">Nicaragua</option> <option value="Niger">Niger</option> <option value="Nigeria">Nigeria</option> <option value="Pakistan">Pakistan</option> <option value="Papua New Guinea">Papua New Guinea</option> <option value="Peru">Peru</option> <option value="Poland">Poland</option> <option value="Portugal">Portugal</option> <option value="Republic of Vanuatu">Republic of Vanuatu</option> <option value="Romania">Romania</option> <option value="Rwanda">Rwanda</option> <option value="Sao Tome and Principe">Sao Tome and Principe</option> <option value="Senegal">Senegal</option> <option value="Serbia">Serbia</option> <option value="Slovakia">Slovakia</option> <option value="South Africa">South Africa</option> <option value="Spain">Spain</option> <option value="Sri Lanka">Sri Lanka</option> <option value="Sudan">Sudan</option> <option value="Sweden">Sweden</option> <option value="Switzerland">Switzerland</option> <option value="Tajikistan">Tajikistan</option> <option value="Tanzania">Tanzania</option> <option value="Thailand">Thailand</option> <option value="The Philippines">The Philippines</option> <option value="Tibet">Tibet</option> <option value="Togo">Togo</option> <option value="Tunisia">Tunisia</option> <option value="Turkey">Turkey</option> <option value="U.S.A.">U.S.A.</option> <option value="Uganda">Uganda</option> <option value="Ukraine">Ukraine</option> <option value="United Kingdom">United Kingdom</option> <option value="Uruguay">Uruguay</option> <option value="Vietnam">Vietnam</option> <option value="Zambia">Zambia</option> <option value="Zimbabwe">Zimbabwe</option> </select>   </div> <div class="field"> Telephone *<br/> <span class="note">(Please include country/area code)</span> <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtTelephone1" type="text" id="txtTelephone1" class="name-input" placeholder=""/>   </div> <div class="field"> Telephone<br/> <span class="note">(Please include country/area code)</span> <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtTelephone2" type="text" id="txtTelephone2" class="name-input" placeholder=""/> </div> <div class="field"> E-mail *<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtEmail" type="text" id="ContentPlaceHolderDefault_cpMain_txtEmail" class="name-input" placeholder=""/>     </div> <div class="field"> Website<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtWebsite" type="text" id="txtWebsite" class="name-input" placeholder=""/> </div> <div class="field"> Contact Person Name *<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtContactPersonName" type="text" id="txtContactPersonName" class="name-input" placeholder=""/>   </div> <div class="field"> Contact Person (Surname) *<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtContactPersonSurname" type="text" id="txtContactPersonSurname" class="name-input" placeholder=""/>   </div> <div class="field"> Position *<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtPosition" type="text" id="txtPosition" class="name-input" placeholder=""/>   </div> <div class="field"> Background Information of the Organization *<span class="note"> - (up to 3,000 characters)</span><br/> <span class="note">Please consider including the organization鈥檚 year of establishment, primary goals and activities, number of personnel and volunteers and the beneficiary groups.</span> <textarea name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtBackground" rows="2" cols="20" id="ContentPlaceHolderDefault_cpMain_txtBackground" class="long-text" placeholder=""> </textarea>   </div> <div class="field"> Budget for Current Year and Most Recent Year鈥檚 Revenues and Expenses * <table> <thead> <tr> <th>Year</th> <th>Revenues</th> <th>Expenses</th> </tr> </thead> <tr> <td> <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtYearCurrent" type="text" id="txtYearCurrent" class="name-input" placeholder=""/>   </td> <td> <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtRevenuesCurrent" type="text" id="txtRevenuesCurrent" class="name-input" placeholder=""/>   </td> <td> <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtExpensesCurrent" type="text" id="txtExpensesCurrent" class="name-input" placeholder=""/>   </td> </tr> <tr> <td> <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtYearRecent" type="text" id="txtYearRecent" class="name-input" placeholder=""/>   </td> <td> <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtRevenuesRecent" type="text" id="txtRevenuesRecent" class="name-input" placeholder=""/>   </td> <td> <input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtExpensesRecent" type="text" id="txtExpensesRecent" class="name-input" placeholder=""/>   </td> </tr> </table> </div> <div class="field"> Currency * <select name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$cmbCurrency1" id="cmbCurrency1" placeholder=""> <option value="Australian Dollar">Australian Dollar</option> <option value="Canadian Dollar">Canadian Dollar</option> <option value="Euro">Euro</option> <option value="Franc Suisse">Franc Suisse</option> <option value="Pound Sterling">Pound Sterling</option> <option value="US Dollar">US Dollar</option> </select>   </div> <div class="field"> Major Sources of Income<br/> <span class="note">* Please indicate percentages of income derived from government, corporations, foundations and/or individuals.</span> <textarea name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtSourcesOfIncome" rows="2" cols="20" id="ContentPlaceHolderDefault_cpMain_txtSourcesOfIncome" class="long-text" placeholder=""> </textarea> </div> <div class="field"> Grant Request *<span class="note"> - (up to 3,000 characters)</span><br/> <span class="note">*Please consider including the purpose, beneficiaries, project location, and timetable.</span> <textarea name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtGrantRequest" rows="2" cols="20" id="ContentPlaceHolderDefault_cpMain_txtGrantRequest" class="long-text" placeholder=""> </textarea>   </div> <div class="field"> Requested Amount<input name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$txtRequestedAmount" type="text" id="txtRequestedAmount" class="name-input" placeholder=""/> </div> <div class="field"> Currency <select name="ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$cmbCurrency2" id="cmbCurrency2" placeholder=""> <option value="Australian Dollar">Australian Dollar</option> <option value="Canadian Dollar">Canadian Dollar</option> <option value="Euro">Euro</option> <option value="Franc Suisse">Franc Suisse</option> <option value="Pound Sterling">Pound Sterling</option> <option value="US Dollar">US Dollar</option> </select> </div> <div class="field last"> <a id="btnSubmit" class="comment-submit" href="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ctl00$ctl00$ContentPlaceHolderDefault$cpMain$btnSubmit", "", true, "", "", false, true))">POST</a> <span id="formposting" style="display:none!important;" class="comment-submit">Posting...</span> </div> </form> <p>In case there is further interest in your request by the Foundation, you will be required to submit more information about this request, as well as additional official documents related to the operation and finances of your organization.</p> <p><br/>If you have any questions or comments, please contact directly our website 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