The Monsanto Fund must determine that your medical research organization would be recognized as tax exempt under U.S. concepts before a grant can be made.

Please fill in the following questionnaire to the best of your ability to help us determine your eligibility for a grant.

1. State the full name and mailing address of your organization.



2. List the name and address of the responsible officer or officers of your organization.



3. Attach a true and correct copy of your organization’s creating instrument. (Articles of Incorporation, Constitution, Articles of Association, Deed of Trust, Indenture,etc.)
   NOTE:If your organization does not have a creating instrument, its request for a grant from Monsanto Fund will not be considered.



4. Attach a true and correct copy of your organization’s By-Laws, Statutes, or other rules governing its operations.
   NOTE:This document is not required to be completed by public medical research organizations.



5. Please state, in narrative form, the activities presently carried on by your organization,as well as any activities it is contemplated will be carried on in the future.
   NOTE: Your organization’s principal function must be continuous active medical research in conjunction with a hospital or an instrumentality of a government unit.Medical research means investigations,experiments and studies to discover,develop or verify knowledge relating to the causes, diagnosis, treatment, prevention, or control of the physical or mental diseases and impairments of man.



6. What benefits,services,or products does your organization provide with respect to its charitable function?



7. Are the recipients of any benefits from your organization required to pay for them?
   NOTE: If the answer is yes, please explain and show how the charges are determined.



8. Does your organization limit its benefits, services or products to specific classes of individuals?
   NOTE: If the answer to the above is yes, explain in detail how the recipients or beneficiaries are selected.



9. Does or will your organization engage in activities involving the influencing of legislation or the intervention in any way in political campaigns?
   NOTE: If the answer is yes, please explain in detail.