Teleflex Foundation - 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 a preliminary phone call.

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.

Phone: (610) 948-2853
Fax: (610) 948-2859
foundation@teleflex.com

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
Please enter the characters from the image below: