Applications for Contributions

If you wish to submit a proposal for consideration by the Tyco Electronics Foundation's Contributions Committee please provide the following information. Submit your proposal with the necessary documents to the address indicated below. See Vision for more detailed information.

Organization Name:
Address:
Phone & Fax:
Organization Contact Name:

• Description of the organization and its purposes
• List of governing board members
• Current operating budget and sources of income for the organization
• Audited financial statement and most recent IRS Form 990
• Copy of IRS determination evidencing Section 501 (c) (3) status

We'd like to know more about your program. Please answer the following questions as succinctly as possible.

1. Briefly describe the program, service or activity for which you are requesting funds, how much you are requesting, and your planned delivery, including goals and activities.
2. Briefly describe the need for the program, service or activity you propose to provide, and how many people you expect to reach. What documentation can you provide that your program is needed?
3. Will you be collaborating with other organizations or agencies on this program? Who are your collaborators, and how will this be accomplished?
4. List any Tyco Electronics employees who volunteer with your organization, and their position if an officer or board member.
5. List the estimated cost of the program and your projected budget. Give the sources of funding that are both committed and proposed.
6. How will you evaluate the success of your program?
7. How have you used previous funding from the Tyco Electronics Foundation, if any?

For More Information, contact:

Mary Rakoczy
The Tyco Electronics Foundation
c/o Tyco Electronics Corporation
P.O. Box 3608
MS 140-10
Harrisburg PA 17105-3608

Phone: (717) 592-4869

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