Wallerstein Fund Application

Wallerstein Fund Grant Application

The criteria to obtain a grant are as follows:

• A woman-owned Business or Organization. WRT members and their relatives are welcome to apply; they will not, however, receive special consideration.

• Start-up business or a business in existence not more than five years.

• Business Plan must be provided.

• Grant Application detailing use for start-up/operating capital, increased or improved technology, additional or improved equipment, or education.

• Recipient must show support for other women by being involved with other women’s organizations or organizations that benefit women.

• Prior Grantees are ineligible.

• A written report will be required of the Grantee within three months of receipt to verify how the funds were/are being used.

• Should the Grantee not comply with the terms of the grant, WRT has the right to request refund of the specified funds within a reasonable time period

Name (First, MI, Last):
Mailing Address:
City:
State:
Zip Code:
Daytime Phone:
Evening Phone:
Date of Birth:
Are you a US citizen?:	YesNo
How long have you lived in the NW Pennsylvania area?:
Are you a member or have you ever been a member of WRT?:	YesNo
Do you know anyone that is a current member of WRT?:
Please describe and women's organizations you are currently involved with or that you volunteer with that benefit women.
Do you currently own your own business?	YesNo
If Yes, please provide a description of the type of business, business model (sole proprietorship, partnership, corporation), etc.:
Description of Products/Services:
Date Established:
Business Name:
Mailing Address:
City:
State:
Zip Code:
If No, is your grant request specifically for the purpose of starting your own business?	YesNo
Do you have a Business Plan?: (A business plan is required, you will be contacted to provide this information)	YesNo
Amount of Grant Request:
For what purpose?:
Please describe in detail how the funds will be used:
What makes you an ideal candidate for this grant?:
Any other comments: