Kansas Professional Grant Association

Name: 

Organization Name: 
Address:

Telephone:                                                                                              Fax:			
E-mail:                              					    
Web site:                                                                                                                                                        
Position/Title: 
Type of Organization:
 Arts/Humanities				 Science/Environment			 Other
 Post Secondary Education			 Social Services
 Primary or Secondary Education		 Medical
	 
Organization’s Mission:

Population Served: 

Types of Grants Sought by Your Organization
 Community Foundation			 Special Purpose			 All of these listed
 Family Foundation				 State					 Not Applicable
 Corporate Foundation			 Federal

Types of Grants Your Organization Funds
 Community Foundation			 Special Purpose			 All of the Above
 Family Foundation				 State					 Not Applicable
 Corporate Foundation			 Federal

Describe any grant funded projects which may be used as a model for others to develop for future proposals? 

Describe any projects which may be open to potential collaboration? 

KPGA Subcommittee you would be interested in serving on:

 q Membership               q Program                   q Workshop		  q Communications

Other pertinent Information, feedback, suggestions, etc.

	
*Please Include a Check to Cover Your $20 Membership Fee Along With This Completed Profile*
$30 agency membership
KANSAS PROFESSIONAL GRANT ASSOCIATION
PO Box 21374 u Wichita, KS 67208
KPGA LIST SERVE ADDRESS: kpga@majordomo.twsu.edu u KPGA EMAIL: tbehrendt@usd259.net