Grant Application

Instructions: Please complete and return. This information will hold your spot in GivingMatters.com™ until your organization’s profile has been completed. Has the organization filed its first 990? YES NO Do you have a State Charitable Solicitations Permit or Letter of Exemption? YES NO If you answered NO to any of these questions, please contact the GivingMatters.com™ staff at (615) 321-4939 before completing the form. Organization Name

Tierra Lucero

Address P.O. Box 932, Taos, NM 87571 ____________ Phone

575-779-5457

Fax 575-776- 3637

Website www.tierralucero.org Executive Director’s Name Bob Pedersen Executive Director’s Email [email protected] Year of Incorporation 2001 here

Tax ID Number (FIN) tax ID goes

Mission Statement (2000 Character Limit) Our mission is to create energy sovereignty for our community through the local production of food and fuel. We seek to develop and demonstrate models that can be used by communities in the U.S. and around the world.

Who should we contact to complete the profile? Pedersen_________________________

Bob

Email address: [email protected]_______________

Attach copy of: • •

501 (c) (3) IRS determination letter State Charitable Solicitations Permit or letter of exemption www.newmexico.gov/sos/charity

Return to: Santa Fe Community Foundation P.O. Box 1827 Santa Fe, NM 87504-1827 Fax: 505.988.1829

Date of application: November 20, 2010 Name of organization. Tierra Lucero 501c3 Purpose of grant: To educate Taos school children about nutrition and local agriculture in order that they may make better food choices, nutritionally and environmentally. Address of organization: P.O. Box 932, Taos, NM 87571 Telephone number: 575-779-5457 Executive director: Bob Pedersen Contact person and title: Jennifer Rice, Director of Fundraising Is your organization an IRS 501(c)(3) not-for-profit? (yes or no): Yes If no, please explain: Grant request: $25,000 Check one: General support: ___ Project support: X Total organizational budget (for current fiscal year): $200,000 Budget Period (mo/day/year): January 1, 2010 - through December 31, 2010 Total project budget (if requesting project support): $47,484 Dates covered by project budget (mo/day/year): June 1, 2010 - December 31, 2010 Project name: Food is Elementary in Taos

Insert 501 (c) (3) IRS determination letter here

Insert State Charitable Solicitations Permit or letter of exemption here