Literacy Grants Application - Literacy Grant Disbursements Request
 

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REQUEST FOR LITERACY GRANT AWARD DISBURSEMENT

 

 

Name: _______________________________________________________________________________

 

 

Organization: ________________________________________________________________________

 

 

Address: ____________________________________________________________________________

 

 

City, State, Zip: ______________________________________________________________________

 

 

Contact Phone Number: ___________________________

 

 

Your Literacy Grant Award may be requested in one or multiple disbursements.    

Indicate the amount requested for purchase or reimbursement in the table below.


 

Attach copy of your purchase order or invoice.  If necessary, indicate which item(s) on the document is associated with your Literacy Project and represents the total of your request.         

 

Forward this Disbursement Request and attachments to:

 

Literacy Grant

ORBRC Foundation

PO Box 4164

Oak Ridge, TN  37831-4164

 

Checks will be made to your organization and returned to your address on our records. Please use the space provided to make corrections or changes.        

 

Allow 2–3 weeks to process your check request. If your check is not received in 30 days, please contact the ORBRC Foundation Treasurer at 865-483-9272 or dubshults@comcast.net.

 

       FOR FOUNDATION REPLY 
 DATE   AMOUNT  CHECK NUMBER  GRANT BALANCE

 



 



 



  

 


ALL DISBURSEMENT REQUESTS RELATED TO 2015 GRANTS MUST BE RECEIVED BY
 

DECEMBER 31, 2015