Expression of Interest

Express Scripts Foundation provides funds for non-profit organizations which meet the guidelines set out in our charter. The following brief expression of interest will allow Express Scripts Foundation to determine whether or not the organization expressing interest will be asked to submit a formal application.

Organization Information

1. Provide your organization’s legal name as it appears on your 501(c)(3) letter.
2. Is your tax-exempt status currently valid?	Yes No
3. What is your organization’s primary mission or goals?
4. How does your organization’s mission or goals align to the Express Scripts Foundation funding philosophy?
5. How many Express Scripts employees (if any) are involved in your organization currently as volunteers?
Please provide the names and roles of Express Scripts employees who are involved in your organization currently as volunteers or are actively involved in your organization.
Contact Information (the primary contact for this application)
Last Name
First Name
Title
Office Phone
E-Mail Address
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Note: The Express Scripts Foundation staff will review this expression of interest and will let you know if it would be appropriate to receive an application.

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