Grant Application Summary Form

The Teleflex Foundation funds non-profits where the company has facilities. To find out if you are in our giving areas, we suggest you email Teleflex Foundation

Please read the Application Guidelines before filling out the Grant Application Summary Form.

Please fill out and submit the Grant Application Summary Form below. If you'd prefer, you can open the Grant Application Summary Form as a PDF to fill out and fax or email.

Fax: (610) 948-2858

Email Teleflex Foundation

Date of Application:
Organization:
Address:
Contact Person Name and Title:
Contact E-mail Address:
Contact Phone Number:
501(c)(3) Organization?	Yes    No
Project Name and Brief Description:
Project Budget:
Amount Requested:
Population/Geographical Area Served:
Total Annual Organizational Budget:
Previous Support from Teleflex - Dates and Amounts
How Did You Find Us?
Does a Teleflex employee serve on your board?	No Yes
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