Otto Breitenbach Grant Application - Madison Sports Hall of Fame Club

Be as succinct and clear in your responses as possible. Applications will be evaluated based upon the depth, quality and clarity of the information provided.

More information on this grant can be found here.

Name(Required)

First Last

Title(Required)

Phone(Required)

Primary representative of the club/organization/school

Email(Required)

Primary representative of the club/organization/school

Organization(Required)

Club/school/youth team

Legal Name of Organization(Required)

Founding Date(Required)

Employer Identification Number

Tax Status(Required)

For Profit

Not for Profit

Address(Required)

Street Address City State ZIP Code

Phone

Website

Sport(s) money used for

Age of Athletes

Number of Athletes

Briefly describe how your organization provides Madison boys and/or girls sport opportunities and explain your organization’s basic philosophy and goals?(Required)

Amount of Financial Request(Required)

Up to $750

Please detail the intended purposes for the grant funds and indicate when these funds will be used. Generally describe how your group’s philosophy and goals will be implemented with these funds.(Required)

This grant request is partially judged on financial need so why would our club’s help substantially assist your organization in meeting its sport goals(Required)

Your organization acknowledges the importance to the Madison Sports Hall of Fame Club (MSHF) of verifying that the funds disbursed to your group are used in the manner described in this application. Your organization agrees to (a) maintain appropriate records of its use of all funds disbursed by the MSHF and (b) promptly upon the request of the MSHF to provide it with copies of such records and any other records the MSHF may reasonably request. Your organization agrees that the MSHF may recover from your group any funds disbursed pursuant to this application that were misused. Your representative represents and warrants that the responses in this questionnaire are true and accurate.

By entering my name here, I am authorized by the organization to submit this form and certify all information provided is accurate(Required)