If you prefer to complete a PDF version of this form and email it to us, please click here. 1 2 3 Organization * Website Type of Philanthropic Organization * Community Foundation Corporate Contributions Program Corporate Foundation Donor Advised Fund Family Foundation Grantmaking 501(c)4 Individual Philanthropist Operating Foundation Philanthropic Association Private/Independent Foundation Public Charity/Public Foundation Other... Type of Philanthropic Organization Other... Please Specify Type of Philanthropic Organization Headquarters Address * City * State * Zip Code * County * Los Angeles Kern Orange Riverside San Bernardino San Luis Obispo Santa Barbara Ventura Outside Southern California Telephone Number Local Address Same as HQ Address Yes No Local Address Local City State Zip Code Telephone Number Employer Identification Number (EIN) Leave this field blank
