Individual Grant Application

MEMORIAL FOUNDATION FOR THE BLIND

799 West Boylston St.

Worcester, MA 01606

508.854.9980

INDIVIDUAL GRANT APPLICATION

1. Contact information for grant applicant.

Street
City
State
Zip

2. If applicable, contact information for person submitting this application on behalf of the grant applicant.

Street
City
State
Zip

7. Please list items or services requested, followed by cost.

Item

Cost

Please note that MFB may contact you for additional clarification if needed.

Revised November 2018