Community Grant Program Application

Contact Information

Salutation

*First Name

Middle Name

*Last Name Job Title

Department

Mail Stop

*Company/University *Street Address 1 Street Address 2

*City

State/Province (US & CA only)

*Zip/Postal Code

County/Province

*Country/Region *E-mail (Format must be valid, e.g., name@yourdomain.com)

Telephone

*Main Number

Extension

If you are outside the U.S. and Canada, include "+country code" before your phone number. (Example: +31-70-555-5555)

Fax

Main Number

	* Check here to confirm that you have read our eligibility requirements (PDF) and that your organization and program meet them.
	* Check here to confirm the tax-exempt status of your organization.

Organizational Information

*Web site address for organization *Describe your organization (history, mission, goals, population served). *Describe the organizational structure (size of staff, board members, annual budget).

Program Information

*Describe the program for which you are requesting funding assistance, including the program budget. *What amount of funding are you requesting from The MathWorks? *Approximately how many individuals will be directly affected by this program? In what ways? *What are your other major sources of funding? * Please outline potential opportunities for volunteer involvement with your program by interested MathWorks staff members. *Please indicate the dates and amounts associated with any previous funding from The MathWorks. *Describe how your program funding request aligns with the goals of our Community Grant Program.

We will not sell or rent your personal contact information. See our privacy policy for details.

Products & Services	Industries	Academia	Support	User Community	Company