Account Information

Recipient Organization

Purpose of Grant

Describe how the grant should be used by the recipient organization (e.g., for operating expenses or a special project)

Indictate the amount of the grant that the organization is to receive:

Grant Amount

Grant Frequency

Is this a recurring grant? YesNo
Issue the approved grant on a recurring basis as indicated below for the amount in the above section.
N/AMonthlyQuarterlySemi-Annually

Support Documentation Confirmation

The following supporting documentation is included with the application:

  • W9 Form - verification of IRS Tax Identification
  • 501 (c) (3) Proof of Non-Profit Organization


Signature

On behalf on myself and, if relevant, any other donors, advisors, and successors of the donor-advised fund, agree that this a recommendation not a direction. I further understand that Kiwi Energy NY LLC reviews all grant applications and that this purpose of this application is in a charitable nature. Kiwi Energy may deny the grant if it does not meet the criteria or there are more significant applications. By ticking the box below, I certify that the grant is NOT intended to:

  • Fulfill an existing pledge (an existing pledge that has been pre-approved)
  • Acquire a benefit, good or service for any specific individual or myself
  • Pay for dues, membership fees, tuition, goods or charitable auction, or other goods or services
  • Support political campaigns, candidates or parties, or lobbying organizations or activities
  • Support a private non-operating foundation or Type III supporting organizations that is not functioning integrated
I certify that my grant meets the above criteria.