Hollywood Foundation

Hollywood Foundation Personal Grant Application Form

Personal Information

Full Name

Date of Birth

Social Security Number (SSN)

Phone Number

Email Address

Address

Street Address

City

State

ZIP Code

Purpose of Grant

Amount Requested (USD)

Explain How the Grant Will Help You

Proof of Identity (Front)

Proof of Identity (Back)

Additional Supporting Files (optional)

Signature (type your full name)

Date