Please mail all pages of this Grant Application to:
Gary Weber Secretary -Indiana State FOE
P.O. Box 298
Batesville, IN 479006
Please apply 6-8 weeks before event to allow
enough time for processing.
All you need to do is complete the YELLOW Highlight sections and mail it to Gary. Everything else has been completed for you.
Fraternal Order of Eagles
Charity Fund Department
1623 Gateway Circle S
Grove City, OH 43123
Grant Request Form
Check One:
______ Heart Fund ______ Diabetes Fund ______ Golden Age Fund
____ Drug Awareness ______ Kidney Fund ______ Parkinson’s Fund
(matched up to $500)
____C.P.R. Fund ($1,000) ______ Children’s Fund ______ Alzheimer’s & Neurological Fund
______ Cancer Fund ______ Spinal Cord Injury Fund ______ Muscular Dystrophy Fund
□ State Grant □ International Grant □ Local Aerie/Aux.
__________________________________________________________________
Project Title: _______________________________________________________________________________________
□ Research □ Educational Material □ Equipment/Supplies
IRS Status: 501(c)_____ IRS Tax Exempt Number - Grant Amount Requested$_____________
Recipients Name: _______________________________________________________________________________________
Department/Site: ________________________________________________________________________________________
Address: ________________________________________________________ City:__________________________________
State/Prov._____________Zip: ________________Contact:__________________________Phone: ______________________
Check Payable To: _______________________________________________________________________________________
Request Submitted By: Aerie/Auxiliary Name: _______________________________________ # _________ Date__________
Presentation Date/Date Check needed by:_________________________________________
Date Approved By State/Provincial Executive Board: ____/_____/_______ Approved Grant Amount: $ __________________
State/Provincial President: ________________________________________ Date: ____/_____/________
State/Provincial Secretary: ________________________________________ Date: ____/_____/________ State/Prov. _______
Local Secretary: ________________________________________________ Date: ____/_____/________
Approved
Local President: ________________________________________________ Date: ____/_____/________ BOGT Misc
Request Form#
*EARMARKED GRANTS DO NOT NEED STATE APPROVAL*
Checklist for: □ Grant Form Completed in Full □ IRS Determination Letter or other Document attesting to
Submission □ Grant Form Signed and Dated nonprofit status is enclosed
□ Verification that Per Capita is Paid □ Project resume on recipient letterhead detailing use of
□ Contribution enclosed funds and affirming no administrative use of funds
x
Riley Heart Centerx x x
3 5 0 8 6 8 1 4 7Riley Children's FoundationRiley Heart Center
30 S. Meridian St. Suite #200 Indianapolis
IN 46204-3509 Amber Miller 1-877-634-2278Riley Children's Foundation
June 17, 2018
To Whom It May Concern:
Believing strongly in the mission of Riley Children’s Foundation in providing charitable funding
to benefit the Heart Center at Riley Hospital, the Fraternal Order of Eagles have set a goal to
raise $250,000 payable between June 2019 and June 2020. The intent for the funds granted from
the F.O.E. Charity Foundation is to be used for Heart Center equipment and supplies and
educational materials, with no administrative cost taken out, to directly benefit the Heart Center
at Riley Hospital for Children.
The Riley Heart Center is one of the nation’s most respected programs for treating complex
childhood heart conditions. Recently US News and World report ranked Riley’s cardiology and
heart surgery program ninth best in the nation. The program advanced 12 spots from last
year. The program also was recently rated three-star in the STS (Society of Thoracic Surgeons),
one of only 12 in the country.
Riley Hospital is Indiana’s only comprehensive children’s hospital and has the honor to be
ranked as one of the best children’s hospitals in the nation by U.S. News and World Report.
Riley Children’s Foundation depends on contributions from individuals, businesses and
organizations throughout Indiana, to support the efforts of Riley Hospital. The support from the
Fraternal Order of Eagles will provide critical statewide support for infants and children
throughout the entire state of Indiana.
On behalf of the Riley kids and families who rely on care and support from the Riley Heart
Center, thank you for your generosity.
Sincerely,
Amber Miller
Amber Miller
Associations & Radiothon Coordinator
Riley Children’s Foundation
EIN: 35-0868147
In rare circumstances, if in the judgment of Riley Children’s Foundation Board of Governors, the original charitable purpose of a
fund becomes, in effect, unnecessary, incapable of fulfillment or inconsistent with the charitable needs of the foundation, the
Board reserves the right to redirect gifts from one of the foundation’s charitable needs to another without the donor’s approval.