Non-Profit Organization/Neighborhood Group Application For H.E.R.O. Mobile Tool Library Program

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Revised 12/07

NON-PROFIT ORGANIZATION/NEIGHBORHOOD GROUP


APPLICATION
For 1017 W. Lapeer St.
Homeowner Education Resource Organization H.E.R.O. Mobile Tool Lansing, MI 48915
Greater Lansing Housing Coalition (517) 372-5980 x13
Library Program

Organization Information (Please Print):


Name_________________________________________________________ Federal Tax ID Number _________________________

Street Address________________________________________________________________________________________________

City, State, Zip Code____________________________________________ Phone Number _________________________________

Email Address: _________________________________________________

Director/Administrator Information (Please Print):


Director/Administrator__________________________________________________ Title___________________________________

Street Address________________________________________________________________________________________________

City, State, Zip Code___________________________________________ Home Phone Number _____________________________

Applicant’s Signature ___________________________________________ Date ______________________

Please provide the names and phone numbers of any additional persons authorized to use the H.E.R.O.
Mobile Tool Library for your organization. * Must complete HERO volunteer training.

Name______________________________________________________________ Phone Number____________________________

Name______________________________________________________________ Phone Number____________________________

Name______________________________________________________________ Phone Number____________________________

Name______________________________________________________________ Phone Number____________________________

If there are any changes to the names listed above authorized to use the H.E.R.O. Mobile Tool Library,
please notify our office in writing or call at 517-372-5980 x13.

For Office Use Only

Identification Number _____________________________ CDBG Service Area Yes No

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